A multicenter retrospective analysis of patients with salivary gland carcinoma treated with postoperative radiotherapy alone or chemoradiotherapy

Rodney Cheng-En Hsieh; Yung-Chih Chou; Chia-Yen Hung; Li-Yu Lee; Bhanu Prasad Venkatesulu; Shiang-Fu Huang; Chun-Ta Liao; Nai-Ming Cheng; Hung-Ming Wang; Chiao-En Wu; Chung-Jan Kang; Miao-Fen Chen; Yu-Fan Cheng; Kun-Yun Yeh; Cheng-Hsu Wang; Wen-Chi Chou; Chien-Yu Lin

doi:10.1016/j.radonc.2023.109891

A multicenter retrospective analysis of patients with salivary gland carcinoma treated with postoperative radiotherapy alone or chemoradiotherapy

Radiother Oncol. 2023 Nov:188:109891. doi: 10.1016/j.radonc.2023.109891. Epub 2023 Sep 1.

Authors

Rodney Cheng-En Hsieh¹, Yung-Chih Chou², Chia-Yen Hung³, Li-Yu Lee⁴, Bhanu Prasad Venkatesulu⁵, Shiang-Fu Huang⁶, Chun-Ta Liao⁷, Nai-Ming Cheng⁸, Hung-Ming Wang⁹, Chiao-En Wu⁹, Chung-Jan Kang⁷, Miao-Fen Chen¹⁰, Yu-Fan Cheng¹¹, Kun-Yun Yeh¹², Cheng-Hsu Wang¹², Wen-Chi Chou¹³, Chien-Yu Lin¹⁴

Affiliations

¹ Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
² Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.
³ Department of Hema-oncology, Division on Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
⁴ Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Radiation Oncology, Loyola University, Chicago, IL, USA; Edward Hines Veteran Affairs Hospital, Chicago, IL, USA.
⁶ Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
⁷ Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
⁸ Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
⁹ Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
¹⁰ Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Taiwan.
¹¹ Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
¹² Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Taiwan.
¹³ Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan. Electronic address: f12986@cgmh.org.tw.
¹⁴ Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Research Core Laboratory, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan. Electronic address: qqvirus1022@gmail.com.

PMID: 37659659
DOI: 10.1016/j.radonc.2023.109891

Abstract

Background: The aim of this study was to interrogate if the use of postoperative chemoradiotherapy (POCRT) correlated with superior oncological outcomes for certain subgroups of patients with high-risk salivary gland carcinoma (SGC), compared with postoperative radiotherapy (PORT) alone.

Methods: This multicenter retrospective study included 411 patients with surgically resected SGC who underwent PORT (n = 263) or POCRT (n = 148) between 2000 and 2015. Possible correlations of clinical parameters with outcomes were examined using the Kaplan-Meier analysis and Cox proportional-hazards regression model.

Results: The median follow-up of survivors is 10.9 years. For the entire cohort, adding concurrent chemotherapy to PORT was not associated with OS, PFS, or LRC improvement. However, patients with nodal metastasis who underwent POCRT had significantly higher 10-year OS (46.2% vs. 18.2%, P = 0.009) and PFS (38.7% vs. 10.0%, P = 0.009) rates than those treated with PORT alone. The presence of postoperative macroscopic residual tumor (R2 resection) was identified as an independent prognosticator for inferior OS (P = 0.032), PFS (P = 0.001), and LRC (P = 0.007). Importantly, POCRT significantly correlated with higher 10-year LRC rates in patients with R2 resection (74.2% vs. 40.7%, P = 0.034) or adenoid cystic carcinoma (AdCC, 97.6% vs. 83.6%, P = 0.039). On multivariate analyses, the use of POCRT significantly predicted superior OS (P = 0.037) and PFS (P = 0.013) for node-positive patients and LRC for patients with R2 resection (P = 0.041) or AdCC (P = 0.005).

Conclusions: For surgically resected SGC, POCRT was associated with improved long-term OS and PFS for patients with nodal metastasis and superior LRC for patients with R2 resection or AdCC.

Keywords: Adenoid cystic carcinoma; Concurrent chemotherapy; Nodal metastasis; Postoperative gross residual tumor; R2 resection; Salivary gland cancer.