Elective neck management for high-grade salivary gland carcinoma

Abstract Purpose To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT). Material/Methods Between October 1964 and October 2009, 59 previously untreated patients with cNo...

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Bibliographic Details
Published in:American journal of otolaryngology 2013-05, Vol.34 (3), p.205-208
Main Authors: Herman, Michael P., MD, Werning, John W., MD, Morris, Christopher G., MS, Kirwan, Jessica M., MA, Amdur, Robert J., MD, Mendenhall, William M., MD
Format: Article
Language:English
Subjects:
Adenocarcinoma - radiotherapy
Adenocarcinoma - surgery
Adolescent
Adult
Aged
Aged, 80 and over
Cancer therapies
Carcinoma, Adenoid Cystic - radiotherapy
Carcinoma, Adenoid Cystic - surgery
Carcinoma, Mucoepidermoid - radiotherapy
Carcinoma, Mucoepidermoid - surgery
Colleges & universities
Dissection
Elective Surgical Procedures
Female
Histology
Humans
Lymph Node Excision
Male
Middle Aged
Multivariate analysis
Neoplasm Recurrence, Local - surgery
Occult sciences
Otolaryngology
Patients
Radiation therapy
Radiotherapy, Adjuvant
Retrospective Studies
Salivary Gland Neoplasms - radiotherapy
Salivary Gland Neoplasms - surgery
Statistical analysis
Surgery
Tumors
Young Adult
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Summary:Abstract Purpose To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT). Material/Methods Between October 1964 and October 2009, 59 previously untreated patients with cNo high-grade salivary gland carcinomas (squamous cell carcinomas were excluded) were treated with curative intent using elective neck dissection (END; n = 41), or elective neck irradiation (ENI; n = 18) at the University of Florida College of Medicine (Gainesville, FL). All patients underwent resection of the primary cancer followed by postoperative RT. The median follow-up period was 5.2 years (range, 0.3–34 years). Results Occult metastases were found in 18 (44%) of the 41 patients in the END group. There were 4 recurrences (10%) in the END group and 0 recurrence in the ENI group. Neck control rates at 5 years were: END, 90%; ENI, 100%; and overall, 93% (p = 0.1879). Cause-specific survival was 94% in the ENI group, 84% in the END group, and 86% for all patients (p = 0.6998). There were 3 reported grade 3 or 4 toxicities. Two patients had a postoperative fistula and one patient had a grade 4 osteoradionecrosis that required a partial mandibulectomy. Conclusions Patients with cNo high grade salivary gland carcinomas who are planned to undergo surgery and postoperative RT likely do not benefit from a planned neck dissection.
ISSN:0196-0709
1532-818X
DOI:10.1016/j.amjoto.2012.11.012