Kim Younghac, Kim Hyojun, Choi Nayeon, Kim Eun-Hye, Cho Junhun, Jeong Han-Sin
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
ORL J Otorhinolaryngol Relat Spec. 2025 Jun 28:1-10. doi: 10.1159/000547198.
Postoperative radiation therapy (RT) is recommended for completely resected T1-2 salivary gland cancer (SGC), if the tumor pathology is adenoid cystic carcinoma, intermediate, or high-grade tumors. In this case series, we reviewed cases of intermediate- or high-grade SGC, managed with curative surgery alone without adjuvant RT, and compared those outcomes with pathology- and tumor stage-matched SGC, treated with surgery and postoperative RT.
We retrieved cases of intermediate- or high-grade tumors arising from the major salivary glands treated with surgery alone without adjuvant RT (N = 29) from the institutional SGC database. The main reasons for no adjuvant RT and treatment outcomes were reviewed in detail. In addition, we established the tumor pathology (grade)- and tumor stage (T1-2N0M0)-matched cases treated with surgery and postoperative RT as comparison groups (N = 59), to investigate relative treatment outcomes.
The overall treatment outcome was 82.7% disease-specific survival (DSS) at a median follow-up of 41 months, with a 10.3% incidence of systemic metastasis in intermediate- or high-grade SGCs treated with surgery alone. The primary reasons for not receiving adjuvant RT were no recommendation by the surgeon (37.9%) and patient refusal of RT (27.6%). Comparisons of the surgery alone and surgery with postoperative RT in tumor pathology (grade)- and tumor stage-matched groups revealed similar treatment outcomes; 100% DSS at 35-50 months in the surgery alone group and 90-100% DSS at 37-60 months in the surgery and postoperative RT group. Meanwhile, patients with advanced SGCs (T3-4 or N+) treated with surgery alone had a DSS of 50.0% at a median follow-up of 63 months, and systemic metastasis was the main cause of treatment failure (37.5%).
Our findings suggest that surgery alone may yield favorable outcomes for a specific subset of early-stage, intermediate- to high-grade SGCs without any adverse pathological features. Further studies are warranted to validate this approach.
对于肿瘤病理为腺样囊性癌、中级别或高级别肿瘤且已完全切除的 T1-2 期唾液腺癌（SGC），推荐进行术后放射治疗（RT）。在本病例系列中，我们回顾了仅接受根治性手术而非辅助性 RT 的中级别或高级别 SGC 病例，并将这些结果与接受手术及术后 RT 治疗的病理和肿瘤分期匹配的 SGC 病例进行了比较。
我们从机构 SGC 数据库中检索了仅接受手术而非辅助性 RT 治疗的主要唾液腺来源的中级别或高级别肿瘤病例（N = 29）。详细回顾了未进行辅助性 RT 的主要原因及治疗结果。此外，我们将接受手术及术后 RT 治疗的肿瘤病理（级别）和肿瘤分期（T1-2N0M0）匹配的病例作为对照组（N = 59），以研究相对治疗结果。
在中位随访 41 个月时，总体治疗结果为疾病特异性生存率（DSS）82.7%，仅接受手术治疗的中级别或高级别 SGC 发生全身转移的发生率为 10.3%。未接受辅助性 RT 的主要原因是外科医生未推荐（37.9%）和患者拒绝 RT（27.6%）。在肿瘤病理（级别）和肿瘤分期匹配组中，单纯手术组与手术加术后 RT 组的比较显示治疗结果相似；单纯手术组在 35 - 50 个月时 DSS 为 100%，手术加术后 RT 组在 37 - 60 个月时 DSS 为 90 - 100%。同时，仅接受手术治疗的晚期 SGC（T3 - 4 或 N +）患者在中位随访 63 个月时 DSS 为 50.0%，全身转移是治疗失败的主要原因（37.5%）。
我们的研究结果表明，对于特定亚组的早期、中级别至高级别且无任何不良病理特征的 SGC，单纯手术可能产生良好的结果。需要进一步研究来验证这种方法。
