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Six patients (Palliative RT) and 3 received definitive RT
Adenoidcystic carcinoma in head and neck cancers
Dr Ajeet Kumar Gandhi
MD (AIIMS), DNB, UICCF (MSKCC,USA)
Assistant professor, Radiation oncology
Dr RMLIMS, Lucknow
Adenoid cystic carcinoma
Adenoid cystic carcinoma (ACC) accounts for 1% of all head
and neck (HN) cancers and about 10-22% of all malignant
tumors of the major and minor salivary glands
Management is challenging: local invasion, perineural
involvement, distant metastasis and recurrence over a
Surgery is the cornerstone of management of ACC.
Adjuvant RT yields DFS advantage, role not well defined
Chemotherapy use is limited to recurrent/metastatic tumors
with response rates of 10%-25%
No consensus exists on the appropriate modality for the
management of these malignancies.
Materials and Methods
Retrospective analysis of 66 patients of non-lacrimal gland ACC
of head and neck (1995-2011) treated at AIIMS, New Delhi.
All patients evaluated in MDT
Surgery was done primarily for all medically operable patients
Adjuvant RT volume included tumour bed without ENI.
Adjuvant radiation dose was 60-64 gray at 2 gray per fraction
over 6-6.5 weeks
Concurrent cisplatin (40 mg/m2 weekly) was added in patients
with positive margin and extra-capsular extension in patients
considered eligible for this intensified approach, else a higher
dose of radiation was used in these cases
Ten patients had
11 necks sampled, 8
57 underwent surgery, positive margin noted in 18 (31%) and PNI
in 10 (17.5%) patients.
Adjuvant RT delivered in 54 (81.8%) patients.
3D-CRT (25), IMRT (4) and IG-IMRT (6) patients, Rest patients 2D-
RT was used
Median RT dose was 60 gray in 30 fractions over 6 weeks.
Of the 18 patients with margin positive disease
8 patients received concomitant chemotherapy (cisplatin 40
Seven patients received higher dose of radiation - 64 gray in
32 fractions over 6.5 weeks
3 patients had re-surgical excision with negative margins
Median follow-up: 23 months
(range: 12-211 months)
Nineteen patients had a
4 distant (3 lung and 1 bone)
2 had both local and distant
metastasis (lung metastasis)
Two years and 4 years DFS rate
were 75% and 71%, respectively.
Review of literature
Study Prognostic factors
Chen et al (UCSF)
Int J Radiat Oncol Biol Phys
T4 disease, perineural invasion,
omission of PORT, and major nerve
Gomez DR et al (MSKCC)
Int J Radiat Oncol Biol Phys 2008;
T4 stage and gross
or clinical nerve involvement: PFS
T4 stage and lymph node involvement:
Bjorndal et al (DAHANCA)
Oral Oncology 2015; 51:1138-42
Stage and margin status: OS & LRC on
RT improves LRC
Takebayashi S et al
Acta Otolaryngol 2018; 138: 73-79
Multicentric retrospective analysis: RT
(>60 Gray) improves LRC and OS rate
NOTCH1 mutations correlates with solid histology and associated
with worse outcomes
Am J Surg Pathol 2017; 41: 1473-1482
EGFR pathway mutations and RAS mutations in SAdCC associated
with poor prognosis.
Oncotarget. 2018 Mar 30;9(24):17043-17055
The current single institutional analysis demonstrated the
superiority of multi-modality management in the form of
surgery and adjuvant radiation in the management of HN
Invasion of skull base/ICE and lymph node involvement
confers poor prognosis
Stratification of patients in risk groups may help identify
those with greatest benefit from adjuvant RT
Molecular profiling may guide treatments in times to come