Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy.
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.
Chen
Allen M
AM
Department of Radiation Oncology, Head and Neck Surgery, University of California, San Francisco Comprehensive Cancer Center, San Francisco, California 94143, USA.
Garcia
Joaquin
J
Bucci
M Kara
MK
Chan
Albert S
AS
Kaplan
Michael J
MJ
Singer
Mark I
MI
Phillips
Theodore L
TL
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