Radiotherapy Adjuvant Radiotherapy

Several reports suggest that the use of adjuvant radiotherapy in conjunction with surgery is superior to surgery alone in the treatment of high-grade and/or advanced cancers of the parotid gland. Theriault and Fitzpatrick23 reported the outcome of 271 with parotid carcinomas. Among these were 64 (24%) mucoepidermoid carcinomas, 50 (18%) adenocarcinomas, 40 (15%) malignant mixed tumors, 39 (14%) adenoid cystic carcinomas, 37 (14%) undifferentiated, 21 (8%) acinic, and 20 (7%) squa-mous cell carcinomas. The prognostic characteristics were similar for the 67 (25%) patients treated by surgery and for the 169 (62%) patients treated with surgery and postoperative radiotherapy. Patients treated with combined therapy had a 10-year relapse-free rate of 62% compared with 22% for those treated by surgery alone. Borthne et al.24 demonstrated that radiation therapy lowered the recurrence rates after surgery and controlled approximately one-third of the inoperable tumors. Their data suggested that a dose-response relationship exists for salivary gland cancers and that the radiation dose should not be <70 Gy in 7 weeks.

Although the addition of adjuvant radiotherapy should not be considered an adequate substitute for clear surgical margins, in many instances it is not possible to obtain negative margins of resection. In such cases, the use of postoperative radiation may enhance local control. In 1994, Sakata et al.25 described 17 patients with positive surgical margins after resection of cancer of the major salivary glands. All patients received postoperative radiotherapy. Overall local control at 5 years was 65%. Shingaki et al.26 compared 22 patients with salivary gland malignancy treated with surgery alone with 22 patients treated with combination surgery and radiotherapy. In the surgery group, local recurrence developed in all 8 patients with evidence of residual disease at the surgical margins, whereas local control was achieved in 7 of 15 patients with positive surgical margins in the combination group, and the control rate was related to the amount of residual disease.

In conclusion, postoperative radiotherapy is generally recommended for patients with poor prognostic indicators, including high-grade tumors, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins. Although a clear-cut survival advantage has not been established, the addition of postoperative radiotherapy improves locoregional control for patients with such adverse prognostic parameters.

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