Parotid ACC: ART may not benefit patients with close margins

  • Zenga J & al.
  • JAMA Otolaryngol Head Neck Surg
  • 5 Jul 2018

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A retrospective review suggests that adjuvant radiotherapy (ART) may not improve disease control in patients with parotid gland acinic cell carcinoma (ACC) whose only histopathologic risk factor is a close (≤1 mm) but negative margin.

Why this matters

  • The benefits of ART in this patient population are unclear.

Key results

  • 9% of patients experienced recurrence (7% distant metastases; 2% local recurrence).
  • 5-year OS was 93% and 5-year DFS was 89%.
  • Absence of high-risk factors (advanced T category, nodal disease, lymphovascular or perineural invasion, high-grade histology, or positive margins) was associated with improved DFS (HR, 0.08; 95% CI, 0.01-0.71 in univariate analysis).
  • In patients without high-risk factors, margins ≤1 mm were associated with higher likelihood of ART (56% vs 7%; difference, 49%; 95% CI, 16%-82%).
  • In the 18 patients with margins ≤1 mm without other high-risk factors, only 1 patient who had received ART experienced a recurrence at 136 months postsurgery.

Study design

  • 45 patients with parotid gland ACC were analyzed for locoregional control, recurrence patterns, survival, and associated factors.
  • Funding: None disclosed.

Limitations

  • Retrospective study.
  • Small patient sample size.
  • Lack of multivariate analysis.

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