MANAGEMENT OF MINOR SALIVARY-GLAND CARCINOMAS

Purpose: To assess the role of radiotherapy alone or in combination wi th surgery in the treatment of patients with malignant minor salivary gland carcinomas. Methods and Materials: Between October 1964 and Nove mber 1992, 95 patients with minor salivary gland carcinomas of the hea d and neck received radiotherapy with curative intent, Eighty-seven pa tients were previously untreated, and 8 were treated for postsurgical recurrence, Fifty-one patients were treated with radiotherapy alone, a nd 44 were treated by surgical resection plus radiotherapy, Patients w ere staged according to the 1983 American Joint Committee on Cancer (A JCC) staging criteria for squamous cell carcinomas. Results: The 20-ye ar actuarial rate of local control was 57% with no significant differe nce according to histologic type, When tumor stage was taken into cons ideration, there were no significant differences in local control acco rding to tumor site, The 12-year actuarial probability of distant meta stases was 40% (19% as the only site of failure), In multivariate anal yses, local control was significantly affected only by tumor stage and treatment type (combined therapy better than radiotherapy alone); tum or stage was a significant predictor of cause-specific survival and fr eedom from relapse, Freedom-from-relapse rates were higher for patient s who received combined treatment(p = 0.068). Conclusions: Treatment o f minor salivary gland carcinomas is usually by combined surgery and r adiotherapy, but there are situations where surgery alone or radiother apy alone may be used, The ability to control these tumors with radiot herapy alone is not widely recognized, In the present series, the tumo r was locally controlled in 20 patients with previously untreated prim ary lesions after radiotherapy alone (2.5 to 21 years) and in 4 other patients who were treated by radiotherapy alone for postsurgical recur rent tumor (3.5 to 14 years after radiotherapy), Contrary to the widel y held belief that local recurrence after radiotherapy eventually deve lops in all patients with adenoid cystic carcinoma, local control has been maintained in 13 patients after radiotherapy alone; 5 of the 13 p atients have been observed for 10 to 17 years.