title: Salivary gland tumors treated with adjuvant intensity-modulated radiotherapy with or without concurrent chemotherapy.
abstract: OBJECTIVE
  To analyze the recent single-institution experience of patients with salivary gland tumors who had undergone adjuvant intensity-modulated radiotherapy (IMRT), with or without concurrent chemotherapy.
  
  
  METHODS
  We performed a retrospective analysis of 35 salivary gland carcinoma patients treated primarily at the Dana-Farber Cancer Institute between 2005 and 2010 with surgery and adjuvant IMRT. The primary endpoints were local control, progression-free survival, and overall survival. The secondary endpoints were acute and chronic toxicity. The median follow-up was 2.3 years (interquartile range, 1.2-2.8) among the surviving patients.
  
  
  RESULTS
  The histologic types included adenoid cystic carcinoma in 15 (43%), mucoepidermoid carcinoma in 6 (17%), adenocarcinoma in 3 (9%), acinic cell carcinoma in 3 (9%), and other in 8 (23%). The primary sites were the parotid gland in 17 (49%), submandibular glands in 6 (17%), tongue in 4 (11%), palate in 4 (11%), and other in 4 (11%). The median radiation dose was 66 Gy, and 22 patients (63%) received CRT. The most common chemotherapy regimen was carboplatin and paclitaxel (n = 14, 64%). A trend was seen for patients undergoing CRT to have more adverse prognostic factors, including Stage T3-T4 disease (CRT, n = 12, 55% vs. n = 4, 31%, p = .29), nodal positivity (CRT, n = 8, 36% vs. n = 1, 8%, p = .10), and positive margins (n = 13, 59% vs. n = 5, 38%, p = .30). One patient who had undergone CRT developed an in-field recurrence, resulting in an overall actuarial 3-year local control rate of 92%. Five patients (14%) developed distant metastases (1 who had undergone IMRT only and 4 who had undergone CRT). Acute Grade 3 mucositis, esophagitis, and dermatitis occurred in 8%, 8%, and 8% (1 each) of IMRT patients and in 18%, 5%, and 14% (4, 1, and 3 patients) of the CRT group, respectively. No acute Grade 4 toxicity occurred. The most common late toxicity was Grade 1 xerostomia (n = 8, 23%).
  
  
  CONCLUSIONS
  Treatment of salivary gland malignancies with postoperative IMRT was well tolerated with a high rate of local control. Chemoradiotherapy resulted in excellent local control in a subgroup of patients with adverse prognostic factors and might be warranted in select patients.
authors.affiliation: Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, MA 02114, USA. jdschoenfeld@partners.org
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Schoenfeld
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
authors.forename: Charles M
authors.initials: CM
authors.lastname: Norris
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000628:therapy; D018277:Carcinoma, Mucoepidermoid / Q000401:mortality / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D003872:Dermatitis / Q000209:etiology; D018572:Disease-Free Survival; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D017239:Paclitaxel / Q000627:therapeutic use; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000401:mortality / Q000628:therapy*; D014987:Xerostomia / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel