ADENOID CYSTIC CARCINOMA OF THE SALIVARY-GLANDS - A REVIEW OF 10 YEARS

A retrospective analysis was performed of 50 patients with adenoid cys tic carcinoma who were seen in the Department of Radiation Oncology, U niversity of Witwatersrand, Johannesburg, South Africa, in the past 10 years, There were 25 men and 25 women with a mean age of 52 years (ag e range, 21 to 88 years), Five patients had metastatic disease, and 17 had neural invasion. Thirty-four patients had surgery (11, complete; 23, microscopic residual), Sixteen patients had radiotherapy as initia l management. The disease-free survival was 26%, overall survival was 29%, and local control was 30% at 10 years. Most recurrences occurred in the first 3 years. Nine patients had metastasis following treatment . The mean survival after metastasis was 15 months. Seven prognostic v ariables were analyzed using the log-rank test. There was no impact of age, site, type of salivary gland (major vs, minor), tumor stage, nod e positivity, or neural invasion on disease-free survival, overall sur vival, or local control. Extent of surgical resection (complete vs. mi croscopic residual) had a significant impact on disease-free survival and local control (P < 0.05) but no impact on overall survival (P > 0. 05) because of the slow-growing nature of these tumors. Similarly, pat ients who had microscopic residual after surgery and were treated with radiotherapy did better than those who had biopsy and radiotherapy, a lthough this was not significant statistically (P > 0.05), Thus, whene ver possible, every attempt must be made to remove all microscopic tum or by surgery, Addition of postoperative radiotherapy with high-energy photons did not improve the locoregional control or survival in our s eries. There is a place for neutrons in the treatment of adenoid cysti c carcinomas in advanced cases of inoperable or recurrent tumors, as a review of literature shows.