title: Adjuvant chemoradiotherapy for locoregionally advanced and high-risk salivary gland malignancies.
abstract: BACKGROUND
  To report the outcomes of patients with locoregionally advanced and high- risk salivary gland malignancies treated with surgery followed by adjuvant chemoradiotherapy.
  
  
  METHODS
  From 09/1991 - 06/2007, 24 high-risk salivary gland cancer patients were treated with surgery, followed by adjuvant chemoradiotherapy for high-risk pathologic features including, perineural involvement, nodal involvement, positive margins, or T3/T4 tumors. Chemoradiotherapy was delivered for 4-6 alternating week cycles: the most common regimen, TFHX, consisted of 5 days paclitaxel (100 mg/m² on d1), infusional 5-fluorouracil (600 mg/m²/d × 5d), hydroxyurea (500 mg PO BID), and 1.5 Gy twice daily irradiation followed by a 9-day break without treatment.
  
  
  RESULTS
  Median follow-up was 42 months. The parotid gland was more frequently involved (n = 17) than minor (n = 4) or submandibular (n = 3) glands. The median radiation dose was 65 Gy (range 55-68 Gy). Acute treatment related toxicity included 46% grade 3 mucositis and 33% grade 3 hematologic toxicity. Six patients required feeding tubes during treatment. One patient progressed locally, 8 patients progressed distantly, and none progressed regionally. Five-year locoregional progression free survival was 96%. The 3 and 5 year overall survival was 79% and 59%, respectively. Long-term complications included persistent xerostomia (n = 5), esophageal stricture requiring dilatation (n = 1), and tempromandibular joint syndrome (n = 1).
  
  
  CONCLUSIONS
  Surgical resection followed by adjuvant chemoradiotherapy results in promising locoregional control for high-risk salivary malignancy patients.
authors.affiliation: Department of Radiation Oncology, Memorial University Medical Center, 4700 Waters Avenue, Savannah, GA 31404, USA.
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Pederson
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Witt
authors.forename: Kerstin M
authors.initials: KM
authors.lastname: Stenson
authors.forename: Louis
authors.initials: L
authors.lastname: Portugal
authors.forename: Tanguy
authors.initials: T
authors.lastname: Seiwert
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Villaflor
authors.forename: Ezra E W
authors.initials: EE
authors.lastname: Cohen
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Blair
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage; D012468:Salivary Gland Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D005472:Fluorouracil; D006918:Hydroxyurea