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. 2017 Feb;78(1):82-88.
doi: 10.1055/s-0036-1584884. Epub 2016 Jul 18.

Stereotactic Radiation for Palliation of Skull Base Recurrences of Salivary Gland Carcinomas: Implications for Tumor Targeting

Zaid A Siddiqui  1 , Edward Melian  2 , Anil Sethi  1 , Vikram C Prabhu  2 , Iris Rusu  1 , Bahman Emami  1 , John P Leonetti  3 , Douglas E Anderson  4
Affiliations

Stereotactic Radiation for Palliation of Skull Base Recurrences of Salivary Gland Carcinomas: Implications for Tumor Targeting

Zaid A Siddiqui et al. J Neurol Surg B Skull Base. 2017 Feb.

Abstract

Background Approximately 3 to 13% of salivary carcinomas recur at the skull base. We report our experience treating these recurrences with stereotactic radiation. Methods In total, 14 patients with skull base recurrence of salivary gland carcinoma were identified. Patient characteristics, treatment parameters, response to treatment, local recurrence-free/overall survival, and patterns of failure were studied. Results All 12 symptomatic patients experienced palliation of symptoms. Two grade 3 toxicities were observed. Local recurrence-free survival after skull base treatment was 28 months (74 months after allowing for additional course of salvage radiotherapy). Overall survival was 153 months from primary diagnosis and 67 months from first skull base failure. Of 13 treatment failures, 8 occurred at margins; the rest were infield. All intracranial failures occurred along meningeal surfaces. Conclusions Stereotactic radiation provides well-tolerated palliation for the majority of patients, but with a high rate of local failure. Due to the propensity for meningeal failures, we suggest increasing margins along the meningeal surfaces when treating these patients.

Keywords: palliation; radiosurgery; salivary gland carcinoma; skull base recurrence; stereotactic radiation.

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Conflict of interest statement

Financial Disclosures None.

Figures

Fig. 1
Fig. 1
Local recurrence-free survival curve for skull base recurrence of salivary cancer patients is shown, both after initial treatment only and allowing for salvage therapy. Estimated median local recurrence-free survival was 28 months (95% CI: 5–51 months) for initial treatment. Estimated median local recurrence-free survival allowing for salvage was 74 months (95% CI: 7–141 months).
Fig. 2
Fig. 2
(a) Overall survival curve since primary diagnosis for salivary cancer patients with skull base metastases is shown. Estimated median overall survival since primary diagnosis was 153 months (95% CI: 27–280 months). (b) Survival curve after skull base recurrence in salivary cancer patients is shown. Estimated median overall survival since skull base disease was 67 months (95% CI: 0–159 months).
Fig. 3
Fig. 3
Clinical course of illustrative patient showing marginal failure after treatment; (a) patient with biopsy-proven sellar recurrence after treatment for right parotid carcinoma, (b) showing complete response after SRS, (c) then showing a contralateral left temporal failure along meningeal surface, anterolateral to the original sellar lesion.
See this image and copyright information in PMC

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