title: Outcomes and prognostic factors in modern era management of major salivary gland cancer.
abstract: OBJECTIVE
  There is a dearth of prospective evidence regarding cancer of the major salivary glands. Outcomes and management of major salivary gland are based largely on retrospective series spanning many decades and changes in surgical, radiation, imaging and systemic therapy strategies and technique. We sought to report contemporary patterns of relapse and prognostic factors for major salivary gland cancer.
  
  
  METHODS
  112 patients with major salivary gland cancers underwent resection with or without adjuvant therapy between January 1997 and September 2010. Outcomes were documented with follow-up until December 2014. Survival was calculated by the Kaplan-Meier method. Log-rank test and Cox proportional hazards regression were performed with locoregional control (LRC), distant control (DC) and overall survival (OS) as the primary outcome variables.
  
  
  RESULTS
  Median follow-up was 55.1 months. Rates of LRC for stage I/II and III/IV at five years were 95.7% and 61.9% respectively. Rates of DC at five years for stage I/II and III/IV were 93% and 56.9% respectively. Multivariate analysis identified larger tumor size, clinical nerve involvement and in parotid cancers, advanced T stage, no adjuvant radiation, and older age at diagnosis to be associated with increased risk of locoregional recurrence (all p<0.05). Distant metastasis was associated with sublingual site, degree of clinical nerve involvement, high grade, tumor size and in parotid tumors additionally deep lobe involvement on multivariate analysis (all p<0.05).
  
  
  CONCLUSIONS
  Several prognostic factors were identified that may help guide decisions regarding adjuvant therapy. DM remains a significant concern in the management of this disease.
authors.affiliation: Departments of Radiation Oncology, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States. Electronic address: njegadeesh@emory.edu.
authors.forename: Naresh
authors.initials: N
authors.lastname: Jegadeesh
authors.affiliation: Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, NC, United States.
authors.forename: Roshan S
authors.initials: RS
authors.lastname: Prabhu
authors.affiliation: Departments of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Magliocca
authors.affiliation: Valley View Hospital, Glenwood Springs, CO, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: Marcus
authors.affiliation: Departments of Radiation Oncology, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
authors.affiliation: Departments of Radiation Oncology, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Vainshtein
authors.affiliation: Departments of Otolaryngology, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: J
authors.initials: J
authors.lastname: Trad Wadsworth
authors.affiliation: Departments of Radiation Oncology, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012468:Salivary Gland Neoplasms / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult
keywords: Head and neck cancer; Radiation therapy; Salivary gland cancer