Risk factors for local recurrence of adenoid cystic carcinoma: The role ofpostoperative radiation therapy

Purpose: Postoperative radiation therapy is often advocated in the treatmen t of patients with adenoid cystic carcinoma (ACC) of the head and neck. A r etrospective analysis was performed to determine prognostic factors for loc al recurrence after surgery and to examine the role of postoperative radiat ion therapy. Materials and Methods: A retrospective analysis of 58 patients undergoing s urgery for ACC of the head and neck at the University of Pittsburgh Medical Center from 1974 to 1994 was performed. Patients were followed up for a mi nimum of 24 months for the development of recurrent disease. The associatio n of recurrence was correlated with clinical factors (age, sex, site, and s tage); postoperative treatment (radiation therapy v no radiation); and path ologic variables (grade, margins of resection, and perineural invasion), an d appropriate statistical analysis was performed. Results: Recurrent disease developed in 59% of patients, despite the additi on of postoperative radiation therapy in 83% of patients. Tumor site was th e single most important factor for the development of locally recurrent dis ease and was correlated with primary tumor stage and resection margins. Loc al recurrence rates were decreased (P =.07) in patients with negative surgi cal margins who were irradiated. Conclusions: Larger perspective randomized trials are necessary to evaluate the efficacy of postoperative radiation, and new treatments need to be inv estigated to improve local control rates for ACC of the head and neck. (Am J Otolaryngol 1999;20:281-286. Copyright (C) 1999 by W.B. Saunders Company) .