title: Adding concurrent chemotherapy to postoperative radiotherapy improves locoregional control but Not overall survival in patients with salivary gland adenoid cystic carcinoma-a propensity score matched study.
abstract: OBJECTIVE
  To compare the long-term outcomes in patients with salivary gland adenoid cystic carcinoma (SGACC) treated with post-operative chemoradiotherapy (POCRT) versus post-operative radiotherapy (PORT).
  
  
  METHODS
  We retrospectively reviewed the records of 91 SGACC patients treated with surgery followed by PORT (n = 58) or POCRT (n = 33) between 2000 and 2013. Treatment outcomes between groups were compared using propensity score matching (1:1 nearest neighbor).
  
  
  RESULTS
  The median radiation dose was 66 Gy, and patients were followed up for a median of 71 months. Cisplatin-based concurrent regimens were the most commonly used chemotherapy schedules. In the entire study cohort, patients undergoing POCRT showed a trend toward higher locoregional control (LRC) rates than those treated with PORT alone at both 5 and 8 years (97 and 97 % versus 84 and 79 %, respectively; P = .066). Distant metastases were the most common form of treatment failure and occurred in 31 (34 %) patients (PORT, n = 17; POCRT, n = 14). After propensity score matching (33 pairs), patients receiving POCRT had 5- and 8 year LRC rates of 97 and 97 %, respectively, compared with 79 and 67 % for patients treated with PORT alone (P = .017). The two groups did not differ significantly in terms of distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). However, a significantly better opioid-requiring pain-free survival (ORPFS) was achieved in POCRT group (P = .038). Subgroup analyses revealed that patients with stage III - IV disease (P = .040 and .017), positive surgical margins (P = .011 and .050), or perineural invasion (P = .013 and .035) had significantly higher 5- and 8 year LRC and ORPFS when treated with POCRT, respectively.
  
  
  CONCLUSIONS
  In SGACC patients, adding concurrent chemotherapy to PORT may increase LRC and ORPFS rates, particularly in presence of stage III - IV disease, positive surgical margins, or perineural invasion. However, no significant differences in DMFS, DFS, and OS were observed.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C.
authors.forename: Cheng-En
authors.initials: CE
authors.lastname: Hsieh
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.affiliation: Department of Biostatistics and Informatics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Lan-Yan
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C.|Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Graduate Institute of Clinical Medical Science, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.|Graduate Institute of Clinical Medical Science, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors.forename: Ku-Hao
authors.initials: KH
authors.lastname: Fang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, No.5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, R.O.C. vstsang@adm.cgmh.org.tw.|Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C. vstsang@adm.cgmh.org.tw.|School of Traditional Chinese Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C. vstsang@adm.cgmh.org.tw.
authors.forename: Yan-Ming
authors.initials: YM
authors.lastname: Tsang
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003528:Carcinoma, Adenoid Cystic / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011184:Postoperative Period; D057216:Propensity Score; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents
keywords: Adenoid cystic carcinoma; Chemoradiotherapy; Head and neck; Postoperative radiotherapy; Propensity score; Salivary gland cancer