title: Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy.
abstract: BACKGROUND
  The optimal treatment for patients with locally recurrent carcinomas of the salivary glands is unclear.
  
  
  METHODS
  Ninety-nine patients underwent salvage surgery for locally recurrent salivary gland carcinomas. Eighty-one (82%) had previously received radiation. Thirty-seven patients (37%) received intraoperative radiation therapy (IORT) to a median dose of 15 Gy (range, 12-18 Gy) at the time of salvage.
  
  
  RESULTS
  The 1-, 3-, and 5-year estimates of local control after salvage surgery were 88%, 75%, and 69%, respectively. A Cox proportional hazard model identified positive margins (0.01) and the omission of IORT (p = .001) as independent predictors of local failure. The 5-year overall survival was 34%. Distant metastasis was the most common site of subsequent failure, occurring in 42% of patients.
  
  
  CONCLUSIONS
  IORT significantly improves disease control for patients with locally recurrent carcinomas of the salivary glands. The high rate of distant metastasis emphasizes the need for effective systemic therapies.
authors.affiliation: Department of Radiation Oncology, Head and Neck Surgery, University of California, San Francisco Comprehensive Cancer Center, San Francisco, California 94143, USA.
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
authors.forename: Joaquin
authors.initials: J
authors.lastname: Garcia
authors.forename: M Kara
authors.initials: MK
authors.lastname: Bucci
authors.forename: Albert S
authors.initials: AS
authors.lastname: Chan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: Mark I
authors.initials: MI
authors.lastname: Singer
authors.forename: Theodore L
authors.initials: TL
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016879:Salvage Therapy