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#1060 Postoperative
Chemoradiotherapy in High
Risk Salivary Gland Cancers
H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE,
AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL
1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org
© 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.
High risk salivary cancers are ordinarily treated with surgery and postoperative radiotherapy
(PORT). Concurrent chemotherapy with PORT (CRT) has been shown to intensify treatment
and improve outcomes in squamous carcinomas of the head and neck. We sought to
retrospectively compare outcomes of PORT and CRT in salivary gland carcinomas.
Patients were included if they met basic criteria for entry on RTOG 1008
• Grade 2-3 adenocarcinoma or mucoepidermoid carcinoma,
• OR Grade 3 salivary duct, acinic cell or adenoid cystic carcinoma [>30% solid
component],
AND
• pT3-4
• pN1-3
• OR pT1-2N0 with close [≤1 mm] or positive margins,
AND
• age ≥ 18 years
66 patients meeting the above criteria were included.
Postoperative
Chemoradiotherapy in High
Risk Salivary Gland Cancers
H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE,
AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL
1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org
© 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.
RT (n= 39) and CRT (n=27) cohorts had the following differences in presenting
characteristics:
Variable
Histology
Margin
Perineural Invasion
Pathological Nodal
Stage
Extracapsular
Extension
Median Radiation Dose
(Gy, range)
RT; N (%)
CRT; N (%)
Grade 2 adenocarcinoma or mucoepidermoid
Grade 3 adenocarcinoma or mucoepidermoid or salivary
duct
Grade 3 acinic cell or adenoid cystic (> 30% solid
component)
Negative
Positive
Negative
Positive
Unknown
N0
10 (25.6)
0 (0)
23 (59.0)
24 (88.9)
6 (15.4)
3 (11.1)
11 (28.2)
28 (71.8)
15 (38.5)
23 (59.0)
1 (2.6)
28 (71.8)
3 (11.1)
24 (88.9)
4 (14.8)
22 (81.5)
1 (3.7)
6 (22.2)
N1-3
11 (28.2)
21 (77.8)
Negative
Positive
Unknown
32 (82.1)
7 (17.9)
0 (0)
10 (37.0)
14 (51.9)
3 (11.1)
<0.001
66 (60-70)
63.5 (29-68)
0.01
On binary logistic regression analysis, only N+ was associated with use of concurrent
chemotherapy, OR 8.91 (95% CI 2.84 – 27.98, p < 0.001).
p-value
0.006
0.09
0.07
<0.001
Postoperative
Chemoradiotherapy in High
Risk Salivary Gland Cancers
p = 0.001
Figure 1: Disease Free Survival
H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE,
AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL
1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org
© 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.
p = 0.793
Figure 2: Disease Free Survival, N+
Cohort
p = 0.793
Postoperative
Chemoradiotherapy in High
Risk Salivary Gland Cancers
Multivariate Analysis
for Disease Free
Survival
N+
Treatment
H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE,
AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL
1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org
© 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.
HR
95% CI
p-value
N0
1.0
Ref
<0.001
N+
5.28
2.41 – 11.53
RT
1.0
Ref
CRT
1.45
0.57 – 3.69
0.435
Conclusion:
In this cohort of high risk salivary cancer eligible for RTOG 1008, post-operative
CRT was not associated with improved outcomes over PORT alone.
Node positive patients, especially N2+, are at highest risk for recurrence. This
subgroup may benefit from the addition of standard or novel systemic therapies.