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- Title
Analysis Of Various Factors On Local Control And Survival In Post Operative Cases Of Malignant Salivary Gland Tumors Treated At Our Regional Cancer Center : A Retrospective Study.
- Authors
Mallupattu, Sumanth Kumar; Kumari, Sanjeeva; Krishna, Rama
- Abstract
BACKGROUND: The role of adjuvant therapy has not been clearly defined in certain subgroups of salivary gland tumors. Elective LN irradiation has been the subject of debate. Our study analyzed various prognostic factors and the role of adjuvant radiotherapy in salivary gland tumors on local control rate and median survival. MATERIALS AND METHODS: We analyzed the data of 84 patients of malignant salivary gland tumors from 2010 to 2015 who underwent primary surgery at our institute with median follow up of 32 months range (3-84 months) using inclusion and exclusion criteria. The role of various factors like type of surgery (conservative/radical), grade of tumor, histology, PNI, margin+, LVSI+, adjuvant RT, Elective LN irradiation, LN dissection and size of primary tumor on local recurrence was evaluated as primary end point. Median survival was our secondary endpoint. Local reactions were evaluated using CTCAE criteria version 4.03. Statistical analysis was done using SPSS version 22.0 RESULTS: Demographic and disease characteristics (Table-1) AGE MEDIAN- 40 YRS RANGE- 8- 74 YRS SEX MALE- 38 % (n=32) FEMALES- 62% (n=52) SITE PAROTID-92.8% (n=78) SUBMANDIBULAR-4.8 (n=4) MINOR SALIVARY GLAND-2.4% (n=2)) SURGERY CONSERVATIVE- 81%( n=68) RADICAL- 19% (n=16) HISTOLOGY MUCO EPIDERMOID - 50% (n=42) ADENOID CYSTIC - 16.6% (n=14) ADENO CA. -14.3% (n=12) ACNIC CELL CA.- 7.1% (n=6) SQUAMOUS CELL CA- 4.8% (n=4) SARCOMA- 4.8 % (n=4) MALIGNANT. EX PLEOMORPHIC ADENOMA-2.4 % (n=2) LN DISSECTION + 43% (n=36) p LN+ 7% (n=6) TUMOR SIZE >4 Cms 52% (n=44) GRADE HIGH-48% (n=40) INTERMEDIATE-14% (n=12) LOW-38% (n=32) LVSI+ 2.5% (n=3) MARGIN+ 7%(n=6) PNI+ 7% (n=6) ADJUVANT RT 62% (n=52) ELECTIVE LNI 38%(n=32) RT DOSE MEDIAN- 55 Gy RANGE- 50 -66 Gy 2 YR LC RATE 69% (n=58) METS+ 17% (n=14) Median age 40 years (range-8-66 yrs), 38% were males and 62% were females, 81% underwent conservative surgery and 19 % underwent radical surgery 2 yr local control (LC) in patients who received adjuvant RT is 88.5% Vs 37.5% who didn't receive adjuvant RT which is statistically significant (p<0.001) [odds ratio 10.6, 95% CI, 2.81-40.3]. High grade, LVSI+, PNI+, margin+, tumor size >4 cm and LN + have shown a trend to decrease local control rate but are not statistically significant. Interestingly, patients who have undergone LN dissection have trend towards decreased LC rate, probably due to more conservative/less aggressive LN dissection in patients who are clinically LN+. patients with elective LN irradiation have a better 2 yr LC rate in high grade and large tumors than low grade and small tumors (70% Vs 41%, p=0.04, 64% Vs 30%, p=0.03 respectively). Adjuvant RT doses of more than 60 Gy does not seem to improve LC in adjuvant setting though statistically not significant. The expected median survival in adjuvant RT is 47 months Vs 40 months for surgery alone (p=0.14). CONCLUSION: Adjuvant RT improves local control with trend towards improvement in survival. ELNI in high grade and large tumours is beneficial. Therapeutic ratio doesn't seem to improve beyond 60 Gy in adjuvant setting with R0 resection.
- Publication
Journal of Cancer Research & Therapeutics, 2017, Vol 13, pS235
- ISSN
0973-1482
- Publication type
Academic Journal