There are no randomised control trials comparing the efficacy of using definitive radiotherapy alone compared to surgery and/or post operative radiotherapy (surgery/RT) to manage patients with salivary carcinoma. In general however, surgery followed by postoperative radiotherapy is considered the treatment of choice and best practice.
Mendenhall et alr reported on a study of 224 patients comparing the use of RT alone vs combined surgery/RT.
- The 10 year overall survival and local control rates were 65% and 75%, respectively, for patients treated with RT alone for T1-3 salivary gland carcinoma.
- Results for T4 disease were less favourable, with 10 year overall survival and local control rates of 21% and 21% respectively.
- Cure rates of 20% using RT alone in this advanced stage patient group were also reported.
Chen et alr in a small study investigating the use of RT alone (n=45), and demonstrated 5 year and 10 year local control rates of 70% and 57% respectively.
- The 10 year control rates for T1-2 vs T3-4 patients was 81% vs 39%.
- T3-4 overall survival and distant metastasis-free rates were 46% vs 67% respectively.
- Patients with tumours originating in the minor salivary glands had a 10 year local control of 44% vs 65% with patients with major salivary gland cancers.
- When dose was analysed, a statistical difference in local control was observed favouring doses > 66Gy (p=0.01). The 10 year rate of local control was 81% (doses > 66Gy) vs 40% (doses < 66Gy).
In a retrospective analysis of 101 patients treated with RT for adenoid cystic carcinoma of the head and neck, Mendenhall et alr reported:
- The 5 year and 10 year local control rates in patients treated with RT alone were 56% and 43%.
- Absolute survival rates at 5 and 10 years for T3 and T4 patients treated with RT alone were 75% and 67%, and 50% and 29% respectively.
The role of concurrent chemoradiation in this patient group is not defined.