ADENOID CYSTIC CARCINOMA OF THE AIRWAY - 32-YEAR EXPERIENCE

Methods: We have reviewed our experience in 38 patients with adenoid c ystic carcinoma of the upper airway seen between 1963 and 1995, The me an age was 44.8 years (15 to 80 years) with a male/female ratio of 1:1 .1, Thirty-two of the 38 patients were treated by resection and recons truction (primary anastomosis 28; Marlex mesh prosthesis 4), Twenty-si x of the 32 patients undergoing resection received adjuvant radiothera py, Six patients with unresectable tumors were treated primarily with radiotherapy only, Results: Pathologic examination revealed local inva sion beyond the wall of the trachea in all patients, In a majority, mi croscopic extension was found in submucosal and perineural lymphatics, well beyond the grossly visible or palpable limits of the tumor, Lymp hatic metastases were relatively uncommon, occurring in only five of 3 2 (19%) patients undergoing resection, Metachronous hematogenous metas tases occurred in 17 of 38 patients (44%). Thirteen of these 38 patien ts (33%) had pulmonary metastases, Sixteen of 32 resections were compl ete and potentially curative, There were two deaths within 30 days of operation. The mean survival in the 14 patients undergoing complete re section was 9.8 years (12 months to 29 years), Sixteen of 32 resection s were incomplete (residual tumor at the airway margin on final pathol ogic examination), with one operative death occurring in this group, T he mean survival in the 15 surviving patients was 7.5 years (4 months to 21 years), Six patients were treated with primary radiation only an d had a mean survival of 6.2 years (2 months to 14.3 years), In the pa tients with pulmonary metastases, mean survival was 37 months (4 month s to 7 years) from the time of diagnosis of the pulmonary metastasis u ntil their death, Conclusion: Adenoid cystic carcinoma of the upper ai rway is a rare tumor, which is locally invasive and frequently amenabl e to resection, Although late local recurrence after resection is a fe ature of this tumor (up to 29 years), excellent long-term palliation i s commonly achieved after both complete and incomplete resection, Ther e was a small difference in survival between patients having complete and incomplete resection, Long periods of control can be obtained with radiotherapy alone, The best results, in this series of patients, wer e obtained by resection, Adjuvant radiotherapy is assumed to favorably influence survival.