2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Reprinted by permission of Head Neck. 2018; 40(7):1343-1355.

| Revised: 12 May 2017

| Accepted: 15 September 2017

Received: 30 August 2016

DOI: 10.1002/hed.24984

O R I G I N A L A R T I C L E

Adjuvant therapy in major salivary gland cancers: Analysis of 8580 patients in the National Cancer Database

Shayan Cheraghlou BA 1 | Phoebe Kuo BA 1 | Saral Mehra MD, MBA 1,2 | George O. Agogo PhD 3 | Aarti Bhatia MD 2,4 | Zain A. Husain MD 2,5 | Wendell G. Yarbrough MD 1,2 | Barbara A. Burtness MD 2,4 | Benjamin L. Judson MD 1,2

1 Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut 2 Yale Cancer Center, New Haven, Connecticut 3 Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 4 Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 5 Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut Correspondence Benjamin L. Judson, Department of Surgery, Yale University School of Medicine, 800 Howard Avenue, YPB 425, New Haven, CT 06519. Email: benjamin.judson@yale.edu Funding information The work for this report was supported by the Yale University School of Medicine Lowe Endowment and the Taylor Opportunity Student Research Fellowship.

Abstract Background: Evidence surrounding the effect of adjuvant treatment in salivary gland cancers is limited. The benefit of adding chemotherapy to adjuvant treatment is also of interest. We investigated the association of these treatments with survival and whether this differed by stage or the presence of adverse features. Methods: A retrospective study of adult salivary gland cancer cases diagnosed from 2004 to 2013 in the National Cancer Data Base (NCDB) was conducted. Results: Treatment with adjuvant radiotherapy was associated with improved sur- vival for both patients with early-stage (hazard ratio [HR] 0.744; P 5 .004) and late- stage (HR 0.688; P < .001) disease with adverse features. Further addition of chemo- therapy to the adjuvant treatment of patients with late-stage disease with adverse features was not associated with a survival benefit (HR 1.028; P 5 .705). Conclusion: Adjuvant radiotherapy is associated with improved survival for patients with adverse features, regardless of stage. The addition of chemotherapy to the adju- vant treatment of patients with late-stage disease with adverse features is not associated with improved outcomes.

K E YWO R D S adjuvant treatment, chemotherapy, National Cancer Data Base (NCDB), salivary gland cancer, survival

1 | INTRODUCTION

adverse features, adjuvant radiotherapy is suggested for patients with late-stage disease, and consideration of it is suggested for patients with early-stage disease. Consideration of adjuvant chemoradiotherapy is also suggested for patients with late-stage disease with adverse features. However, given the rarity and histologic heterogeneity of salivary malignan- cies as a whole, data on the efficacy of both adjuvant radio- therapy and chemoradiotherapy are limited in these settings. Previous work has suggested improved locoregional con- trol with the use of adjuvant radiotherapy for salivary gland

Malignant salivary gland tumors comprise approximately 5% of cancers of the head and neck. 1 Surgery is considered the most effective primary treatment modality for these cancers. 2 – 4 However, the postoperative therapy of these patients remains a subject of debate. The National Compre- hensive Cancer Network (NCCN) treatment guidelines divide patients between an early-stage group (I/II) and a late- stage group (III/IV). 5 Based on the presence of certain

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