Adenoid cystic carcinoma of the head and neck

Adenoid cystic carcinoma (ACC) is a rare malignant tumour believed to arise from the epithelial cells of mucous-secreting glands. It is a slow-growing but aggressive tumour with a propensity for perineural invasion. A 10 year review of 45 patients (19 males and 26 females with a median age of 56 yea rs) treated for ACC at a single institution between 1989 and 1999 was perfo rmed to analyse factors involved in treatment failure, local control, treat ment-related morbidity and mortality. The data collected were treated for s urvival curves according to the Kaplan-Meier method and the log-rank test w as used to assess the statistical significance of the various groups. The o verall survivals at 3 years and 5 years were 71% and 65%, respectively, whi le the disease-free survivals at 3 years and 5 years were 73% and 63% respe ctively. Out of the 45 patients, only six had local recurrences, yielding a n 87% locoregional freedom from relapse; 16 patients (35.6%) developed dist ant metastases, with the lung (8/16) being the commonest site. Patients tre ated for tumours of the nose and paranasal sinuses experienced more morbidi ty than those with tumours at other sites. Positive margins, perineural inv asion and solid histology of ACC were associated with increased morbidity a nd treatment failure. Patients treated with combined therapy did better tha n those who underwent a single treatment modality. (C) 2001 The British Ass ociation of Plastic Surgeons.