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Radiotherapy for adenoid cystic carcinomas of the head and neck: clinical outcomes and patterns of failure

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Our goal was to evaluate the use of postoperative or definitive radiotherapy for primary adenoid cystic carcinoma in the head and neck and to determine prognostic variables.

Methods

From April 1973 to June 2009, 44 patients were treated with radiotherapy at Stanford University, 3 definitively and 41 postoperatively.

Results

Median follow-up was 59 months (range, 10–246) for all patients and 56 months for living patients. The median radiation dose was 60 Gy (range, 50–76) with 35 % of patients being treated with IMRT. Five patients (11 %), 1 patient (2 %), and 19 patients (43 %) developed local, regional, and distant failures, respectively. The 5-year and 10-year progression-free and overall survival rates were 57/47 % and 71/59 %, respectively. No patients with negative surgical margins have had a local recurrence. On univariate analysis, residual microscopic and macroscopic disease correlated with progression-free survival (p = 0.048 and p = 0.032, respectively). Residual microscopic disease (p = 0.019), skull base invasion (p = 0.032), and T-classification (p = 0.022) correlated with overall survival. Nine patients experienced acute grade ≥3 toxicity. Eight patients (18 %) developed late grade ≥2 toxicity, including three patients treated with chemoradiotherapy that included a stereotactic boost for gross residual disease, all of whom developed temporal lobe necrosis.

Conclusions

Local control for adenoid cystic carcinoma treated with either postoperative or definitive radiotherapy is excellent. Distant metastasis is the predominant pattern of failure, and treatment failure overall is strongly associated with residual disease status. Stereotactic boosts should be used with caution in patients treated with definitive chemoradiation.

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Conflicts of interest

Daniel Chang M.D. has received research funding from Varian. Quynh-Thu Le M.D. has received research funding from Varian and Amgen. Otherwise, Drs. Chang and Le have no financial or other relationships which may lead to a conflict of interest.

David B. Shultz, M.D., Ph.D., Youssef H. Zeidan, M.D., Ph.D., James D. Murphy, M.D., M.S., Wendy Hara, M.D., and Michael J. Kaplan, M.D., declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stanford University and Cancer Institute, Stanford, CA, USA

    David B. Shultz, Youssef H. Zeidan, James D. Murphy, Wendy Hara, Michael J. Kaplan, Quynh-Thu Le & Daniel T. Chang

  2. Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA

    Daniel T. Chang

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  1. David B. Shultz
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  2. Youssef H. Zeidan
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  3. James D. Murphy
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  4. Wendy Hara
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  5. Michael J. Kaplan
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  6. Quynh-Thu Le
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  7. Daniel T. Chang
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Corresponding author

Correspondence to Daniel T. Chang.

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No human or animal subjects were involved in this retrospective study.

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Shultz, D.B., Zeidan, Y.H., Murphy, J.D. et al. Radiotherapy for adenoid cystic carcinomas of the head and neck: clinical outcomes and patterns of failure. J Radiat Oncol 3, 49–56 (2014). https://doi.org/10.1007/s13566-013-0098-3

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  • DOI: https://doi.org/10.1007/s13566-013-0098-3

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