Improved treatment of salivary adenocarcinomas: planned combined surgery and irradiation

The treatment outcome of 47 patients with adenocarcinoma of major and minor salivary gland origin treated at the Washington University Medical Center between 1960 and 1980 was retrospectively reviewed by site, histologic grade, and treatment modality. Planned irradiation with surgery was the initial treatment for 21 patients, irradiation alone for 14 patients, surgery alone for 11 patients, and chemotherapy for 1. Four patients presented with distant metastases at diagnosis and were not treated definitively. Twenty-seven patients had tumors histologically graded at the time of original treatment; one-third of these were low-grade, and two-thirds were high grade. Treatment results were analyzed in terms of local control as well as overall survival. Median survival for the entire group was 4.1 years. Local-regional disease control was significantly improved in the combination therapy group (81%) compared with the groups treated with irradiation alone (29%) and surgery alone (8%). Disease free survival was also significantly improved with combination therapy. Patients with low-grade adenocarcinoma had better local control and survived longer than those with high-grade. However, one-third of the patients with high-grade tumors survived 5 years. We conclude that both local disease control and survival of patients with adenocarcinoma of salivary gland origin were improved with the planned combination of irradiation and surgery.