Practice Patterns in Management of Low- to Intermediate-Grade Salivary Gland Carcinoma: A Multi-Institutional Study.
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Sajisevi Mirabelle, Nguyen Kenny, Callas Peter, Holcomb Andrew J, Vural Emre, Davis Kyle P, Thomas Carissa M, Stein John S, Asarkar Ameya, Aulet Ricardo, Bell Rebecca K, Blasco Michael A, Bowmaster Vanessa B, Burruss Clayton P, Chung Jeffson, Chan Kimberly, Chang Brent A, Coffey Charles S, Cognetti David M, Cooper Dylan J, Cordero Joehassin, Donovan John, Du Yue Jennifer, Dundar Yusuf, Dedivitis Rogerio, Edwards Heather, Erovic Boban M, Eskander Antoine, Feinberg Philip A, Garvey Emily A, Goldstein David, Goodman Joseph F, Goulart Rafael N, Goyal Neerav, Grasl Stefan, Giurintano Jonathan, Gupta Nikita, Habib Andy, Hackman Trevor, Hara Jared H, Henson Christina, Hinni Michael L, Hua Nadia, Johnson-Obaseki Stephanie, Juloori Aditya, Kalman Noah S, Kejner Alexandra, Khaja Sobia F, Ku Jamie A, Lambert Arnaud, Luu Bao K, Magliocca Kelly R, Medina Dos Santos Luiz R, Michael Cara, Miles Brett, de Melo Giulianno Molina, Moore Michael G, Morand Gregoire B, Moura Kauê, Noroozi Hesameddin, Patel Rusha, Paydarfar Joseph, Plonowska-Hirschfeld Karolina A, Sadeghi Nader, Savaria Fabrice, Schmitt Nicole C, Shapiro Justin, Shaver Timothy B, Stoeckli Sandro J, Stokes William Alvo, Sulibhavi Anita, Tasoulas Jason, Vendra Varun, Vinh Daniel B, Virgen Celina G, Woody Neil M, Young Geoffrey D, Kakarala Kiran, Enepekides Danny J, Hier Michael P, Davies Louise, Ryan William R
Аннотация
METHODS: Analysis of a registry of patients who underwent parotid and submandibular gland resections for low-and intermediate-grade carcinomas between 2010 and 2019.
RESULTS: Of all 786 patients included in the study, 726 (92%) had preoperative imaging and 653 (83%) had preoperative biopsy. Of the 729 patients with parotid gland cancer, the majority underwent superficial (n = 384, 53%) or total (n = 254, 35%) parotidectomy. In patients with facial nerve preservation, total parotidectomy was associated with a significant increase in transient facial weakness (72/177 (41%) vs. 82/311 (26%), RR 0.65, 95% CI 0.50-0.84, p < 0.05) and permanent facial nerve weakness (23/176 (13%) vs. 16/301 (5%), RR 0.41, 95% CI 0.22-0.75, p < 0.05) compared to superficial parotidectomy. Adjuvant radiation therapy (RT) was delivered to 285 (36%) patients. The proportion of patients receiving adjuvant RT declined significantly over the time period from 2015 to 2019 compared to 2010 to 2014 at 162/504 (32%) and 123/282 (44%), respectively (RR 0.74, 95% CI 0.61-0.89, p < 0.05). When comparing the time periods from 2015 to 2019 and 2010 to 2014, there was no significant difference in local control rates (RR 0.52, 95% CI 0.26-1.04, p = 0.06) or regional control rates (RR 0.75, 95% CI 0.26-2.13, p = 0.58).
CONCLUSIONS: Management of low- and intermediate-grade salivary cancer from 2010 to 2019 was variable, which is expected given the rarity and heterogeneity of the disease and the lack of treatment guidelines prior to 2021. Most patients with parotid malignancies underwent superficial or total parotidectomy. The extent of parotidectomy had an impact on facial nerve function outcomes. Delivery of adjuvant radiation trended down with time. The data presented here will support dissemination of the guidelines and provide data that could inform future trials.
LEVEL OF EVIDENCE: 2b.