Submandibular gland carcinoma; an audit of local control and survival following adjuvant radiotherapy

Clinicopathological Factors are Predictors of Distant Metastases From Salivary Gland Carcinoma After Surgery Combined With 125I Internal Brachytherapy

PURPOSE

Distant metastasis (DM) indicates a poor outcome from cancer treatment. The present study estimated the incidence of DM and identified risk factors associated with development of DM in patients with salivary gland carcinoma that achieved locoregional control after surgery combined with ¹²⁵I internal brachytherapy.

MATERIALS AND METHODS

A retrospective cohort study was performed using consecutive patients treated with surgery combined with ¹²⁵I internal brachytherapy at the Peking University School and Hospital of Stomatology. Variables that might be associated with DM, including clinical, treatment characteristics, pathologic findings, and time to DM were recorded. Kaplan-Meier was performed to estimate incidence of DM, and Cox proportional hazard model was used to identify factors associated with DM.

RESULTS

Data from 156 patients were obtained for statistical analysis. The DM was observed in 16 of 156 with rate being 10.3%. The median interval from diagnosis of primary tumor to DM was 30.0 months. The 3-, 5-, 10-year overall survival rates were 97.0, 94.6, 85.2%, respectively, for patients without DM compared with 60.9, 52.2, 26.1%, respectively, for those with DM (P < .001). Univariate analysis revealed that the factors that significantly influenced DM were primary tumor site (P = .012) and histologic grade (P = .001). Multivariate Cox proportional hazard model indicated that histologic grade was the most important risk factor for predicting the risk of DM (P = .005; hazard ratio: 2.79; 95% confidence interval: 1.36 to 5.72).

CONCLUSIONS

Histologic grade was the major risk factor that significantly influenced DM in patients with salivary gland carcinoma that achieved locoregional control. Patients with high-grade tumors should be under close evaluation for DM.

Submandibular gland cancers: prognostic factors and survival analysis

PURPOSE

The aim of this study is to evaluate prognosis and prognostic factors affecting oncological outcome.

METHODS

Records of the subjects managed for a submandibular gland cancer (SGC) between January 1997 and June 2014 were retrospectively reviewed. Survival outcomes were analyzed. All subjects had a minimum follow up of 5 years or until death.

RESULTS

Of 24 subjects (13 male, 11 female), 16 (64.6%) were adenoid cystic carcinoma (ACC). Eight patients had clinically positive neck nodes and 2 of the 16 clinically negative necks were also positive histologically. None of the subjects had distant metastases at presentation. The Kaplan-Meier 5-year estimated locoregional control (LRC), distant metastasis free survival (DMFS), disease free survival (DFS) and overall survival (OS) were 62.5%, 83.3%, 58.3% and 66.7%, respectively. American Joint Committee on Cancer (AJCC) overall stage and extra glandular extension (EGE) proved to be significant predictors of LRC. Only smoking was found to be a significant factor related with lower DMFS and only EGE significantly lowered DFS. Positive nodal stage and positive surgical margin were proved to be significant predictors of OS.

CONCLUSION

Surgery alone is effective in subjects with early stage, noninvasive and low-grade cancers. Despite aggressive treatment, locoregional recurrence was common in subjects who were at advanced stage.

Lymph node ratio predictive of recurrence, distant metastasis, and survival in submandibular gland carcinoma patients

PURPOSE

Submandibular gland (SMG) carcinoma has an unfavorable clinical course and a low survival rate. Specific tumor and nodal findings might help predict posttreatment recurrence and survival in SMG carcinoma patients. This study evaluated factors predictive of posttreatment recurrence and survival in SMG carcinoma patients.

METHODS

This study enrolled 99 consecutive patients with previously untreated SMG carcinoma. All patients underwent tumor and metastatic lymph node resection along with or without radiation/chemo-radiation. The predictive clinical and pathological factors for disease-free survival (DFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were determined using univariate and multivariate Cox proportional hazards regression analyses.

RESULTS

The median tumor size was 2.7 cm and 53 patients (53.5%) had high-grade tumors. The rates of initial nodal and distant metastasis at initial presentation or follow-up were 45.5% and 42.4%, respectively. The actuarial 5-year DFS, DMFS, DSS, and OS rates were 46.4%, 55.9%, 61.5%, and 59.7%, respectively. The independent factors associated with poor DFS, DMFS, DSS, and OS outcomes (all p < 0.05) were T3-T4 classification and lymph node ratio. A histological high-grade tumor was an independent prognostic factor predictive of poor DMFS, DSS, and OS outcomes (all p < 0.05).

CONCLUSIONS

A high rate of distant site failure is associated with SMG carcinoma, resulting in a poor survival rate. Lymph node ratio might help predict recurrence, distant metastasis, and death due to SMG carcinoma.

[Sub-mandibular tumors: epidemiological and histological profiles]

Introduction

Il s'agit de déterminer les profils épidémiologiques et histologiques des tumeurs submandibulaires.

Méthodes

Il s'agissait d'une étude rétrospective et descriptive de 10 ans (1er janvier 2000 au 31 décembre 2009), réalisée dans le service universitaire d'ORL de l'hôpital de Fann. Etaient inclus dans cette étude tous patients porteurs d'une tumeur submandibulaire (opéré ou non), confirmée par un document histologique.

Résultats

Vingt-une tumeurs submandibulaires ont été colligées. L’âge moyen des patients était de 34,42 ans (± 14,10), avec des extrêmes de 2 et 55 ans. Quinze patients (71,4%) étaient de sexe féminin, soit un sex-ratio de 0,4. Les résultats histologiques étaient obtenus à partir de 4 biopsies et de 17 pièces opératoires. Dans 13 cas (61,9%) la tumeur était bénigne et dans 8 cas (38,1%) la tumeur était maligne. L'adénome pléomorphe dans 12 cas (57,1%), le carcinome épidermoïde dans 4 cas (19%) et l'adénocarcinome dans 2 cas (9,5%) étaient les types histologiques fréquents. Treize (13) patients étaient porteurs d'une tumeur bénigne, dont huit (8) patients étaient de sexe féminin. Huit (8) patients étaient porteurs d'une tumeur maligne. Sept patients étaient de sexe féminin.

Conclusion

Cette étude sur les tumeurs submandibulaires est marquée par une prédominance féminine et une fréquence élevée des adénomes pléomorphes et des carcinomes épidermoïdes.

Clinicopathological factors are predictors of distant metastasis from major salivary gland carcinomas

The risk of distant metastasis of salivary gland cancers has usually been associated with histological type, tumour size, and site. The aim of this study was to evaluate a series of patients with major salivary gland carcinomas in order to identify potential risk factors associated with distant metastasis. 255 patients treated for major salivary gland carcinoma in Brazil from 1953 to 2004 were reviewed. Clinical and treatment data were obtained from the medical records and histological features reviewed. 57 (22%) of 255 patients had distant metastasis. The lungs were the most common metastatic site (40 cases, 65%) and adenoid cystic carcinoma the most frequent histological type involved (27 cases, 47%). The percentage of tumours in the submandibular, parotid, and sublingual glands that presented distant metastasis was 42%, 20%, and 17%, respectively. These results provide evidences that clinicopathological factors (tumour site and histology) are significant predictors of distant metastasis in patients with major salivary gland carcinomas.

Primary epithelial submandibular salivary gland tumours--review of management in a district general hospital setting

Primary epithelial submandibular gland (SMG) tumours are uncommon, accounting for 8-12% of all salivary gland neoplasms, and most studies come from large specialised centres. There is little published about the relative frequency and outcome of SMG tumours treated in general hospitals. A retrospective study from two district general hospitals over a 10 year period (1996-2005). Seventeen benign (68%) and eight malignant (32%) tumours were included. A painless mass was the most common presentation. Pain and paraesthesia were not pathognomonic of malignancy. Pleomorphic adenoma accounted for all 17 benign tumours and adenoid cystic carcinoma was the commonest malignant tumour. Fine needle aspiration cytology (FNAC) accurately identified 78% of the benign tumours but none of the malignant tumours. Pre-operative imaging was also unable to distinguish malignant from benign tumours. Incomplete excision was reported in 20% of cases and was more common for malignant tumours. It may be difficult to distinguish benign from malignant SMG tumours on clinical examination and pre-operative investigations. Any suspected submandibular tumour should be considered for early treatment even when FNAC is suggestive of a benign tumour.

Carcinomas arising in the submandibular gland: high propensity for systemic failure

BACKGROUND

Cancers of the submandibular gland are uncommon and only a few small series have reported patient survival and prognosis.

METHODS

We examined the treatment outcomes of 62 patients with surgically treated submandibular gland carcinomas. All patients underwent surgical excision with/without neck dissection, and 41 received postoperative radiotherapy for high-grade, invasive, positive margin, or regionally metastatic tumors. The locoregional control and survival rates were calculated by the Kaplan-Meier method and prognostic factors were calculated from uni- and multivariate analyses.

RESULTS

Of the 62 submandibular gland carcinomas, 19 were adenoid cystic, 11 were mucoepidermoid, and 10 were salivary duct carcinomas, and 8 were carcinomas in pleomorphic adenoma. Actuarial 5-year locoregional control, distant metastasis-free survival, disease-free and overall survival rates were 69.7%, 65.8%, 52.8%, and 56.8%, respectively. In multivariate analysis, T category and histological grading were prognostic for disease-free survival (P < 0.01), and T category and resection margins were prognostic for locoregional control (P < 0.02). Distant metastases were found in 21 patients (33.9%) at initial staging (n = 2) or follow-up (n = 19).

CONCLUSIONS

Despite effective locoregional treatment, approximately one-third of patients with submandibular gland carcinomas may fail systemically, resulting in poor survival. New, more effective therapies may be required for these patients.

Transcervical Submandibular Sialoadenectomy

The submandibular glands are subject to several pathologies that require excision. The most common problem that affects these salivary glands is sialadenitis combined with sialolithiasis. This problem occurs in the submandibular gland 10 times more frequently than it does in the parotid gland. Other illnesses frequently involving the submandibular glands are represented by sialadenosis and benign, malign, and intermediate neoplasms. Diagnosis of any disturbance in the submandibular gland involves both a clinical and instrumental (echography, traditional radiography [ortopantomography] and eventually computed tomography (CT) or magnetic resonance imaging) assessment. Surgery is the usual method of treatment of both chronic sialadenitis and neoplasms in the submandibular gland. A submandibular gland surgical approach can be cervical, intraoral, or endoscopic. The authors present their clinical experience with a total of 40 patients with illnesses involving the submandibular gland treated with submandibular gland excision by a transcervical approach. Their experience suggests that this approach entails a relatively simple procedure, involves low risks for the nerve structure around the gland, permits wide resection margins for neoplasms, and incurs little aesthetic damage.

Les tumeurs des glandes salivaires

Tumors of salivary glands arise mainly from the parotid gland. Magnetic Resonance Imaging (MRI) is mandatory not only to localize precisely the tumor within the gland but also to differentiate between benign and malignant neoplasms, in competition with cytology in fine-needle aspiration biopsy. Tumors without risk of transformation, such as adenolymphoma, are not systematically operated on. Indications of roentgenotherapy and irradiation volumes depend on histologic type, localisation and size of the tumor.

Tumors of the submandibular gland: Clinicopathologic analysis of 23 patients

PURPOSE

Tumors of the submandibular gland are rare, comprising less than 2% of head and neck neoplasia. Both benign and malignant lesions show a mild symptomatology, resulting in late presentation and in advanced stage of disease. The purpose of this article was to report our experience in treating submandibular gland neoplasia during the last 10 years.

PATIENTS AND METHODS

The medical records of all patients with histologically confirmed epithelial tumors of the submandibular gland were retrospectively reviewed. This review found 23 patients with 9 benign and 14 malignant tumors. The collection of data included demographic data, diagnostic procedures, operative and pathology reports, complications, additional treatment, and follow-up.

RESULTS

There were 10 men and 13 women with a mean age of 60 years. Pleomorphic adenoma was the most frequently encountered benign tumor; adenocarcinoma and adenoid cystic carcinoma had an equal presentation in the malignant group of patients. Eleven of the 14 patients with malignant tumors presented in advanced stages of disease (stage III and IV). Surgery was the sole treatment for the benign tumors. There were no recurrences. In the majority of cases, patients with malignant tumors were treated with surgery and postoperative radiotherapy. Eight patients died during the follow-up period, giving a mortality rate of 61.5%.

CONCLUSION

Benign submandibular gland tumors manifest a mild course of disease, and local excision along with the gland is a safe and effective method of treatment. Malignant tumors have a poor symptomatology that results in late diagnosis. Radical surgery and postoperative radiotherapy is the treatment of choice. Prognosis depends on the histopathology and biologic behavior of the specific type of malignant tumor.

Survival and prognosis for cancer of the submandibular gland

PURPOSE

We sought to determine survival and factors affecting survival for patients with cancer of the submandibular gland.

METHODS

All cases of surgically treated cancer of the submandibular gland were extracted from the Surveillance, Epidemiology and End Results database for the time period 1988 to 1998. After tabulation of demographic, tumor-specific, and survival data, Kaplan-Meier survival analysis was conducted according to histopathologic results. Cox regression analysis stratified for histopathology was conducted to determine factors that influenced survival.

RESULTS

A total of 370 cases of submandibular gland cancer were analyzed. Adenoid cystic carcinoma accounted for 42.2% of cases followed by mucoepidermoid carcinoma (22.2%). Overall mean, median, and 5-year survival times and rate were 82 months, 97 months, and 59.7% for the entire cohort, respectively. Adenoid cystic carcinoma exhibited the best mean survival (99 months), whereas squamous cell carcinoma exhibited the poorest mean survival (52 months). Younger age, decreased tumor grade, and radiation therapy were found to improve survival (P <.001,.005, and.015, respectively). Gender, tumor size, extraglandular extension, and nodal positivity did not statistically influence survival.

CONCLUSIONS

Significantly different survival can be expected depending on individual tumor histopathology in submandibular gland cancer. Tumor grade and radiation therapy have important effects on prognosis.