[Adenoid cystic carcinoma of the major and minor salivary glands. Retrospective analysis of 74 patients]

Abstract

Purpose: In this study we give a clinical review of our experience with adenoid cystic carcinoma (ACC) and compare our results with those reported in the literature.

Patients: Between 1981 and 2000, 74 patients with ACC of the head and neck were treated at the Department of Oral and Maxillofacial Surgery, Hannover Medical School.

Results: The average age at diagnosis was 58 years. There were 38 men and 36 women. The primary site was the parotid gland in 4 cases, the submandibular and sublingual gland in 21 cases, the lacrimal gland in 1 case, the minor salivary glands of the oral cavity and oropharynx in 44 cases, and the nasal cavity and maxillary sinus in 4 cases. There were 19 T1, 15 T2, 9 T3, and 31 T4 tumors with perineural invasion of 32 tumors. R0 resection was performed in 45 cases. Fourteen patients received postoperative radiation. There were only five N1 and two N2b necks. All patients were staged M0 at presentation. Local control rates at 5, 10, and 15 years were 64%, 56%, and 52% with a mean local control time of 11.1 years. Tumor size ( p< or =0.001), margin status ( p< or =0.001), and perineural invasion ( p</=0.001) showed significant influence on local control. However, we were not able to demonstrate a positive effect of postoperative radiation. Distant control rates at 5, 10, and 15 years were 72%, 62%, and 59% with a mean distant control time of 14.4 years. Distant failure was diagnosed in lungs and bones and occurred independently of local treatment outcome. Overall survival rates at 5, 10, and 15 years were 71%, 54%, and 37% with a mean overall survival of 11.2 years. Recurrence-free survival rates at 5, 10, and 15 years were 57%, 45%, and 37% with a mean recurrence-free survival of 9.1 years. The survival rates at 5, 10, and 15 years after diagnosis of tumor progression were 35%, 15%, and 0% with a mean survival time of 4.7 years.

Conclusion: Our results provide insights on the unusual nature of these tumors, which may be useful for making clinical decisions. However, prospective randomized studies are needed to define the optimal treatment for patients with ACC with special regard to adjuvant treatment modalities.