Ten Year Experience with Surgery and Radiation in the Management of Malignant Major Salivary Gland Tumors

Background: Despite being rare in incidence, malignant tumors of major salivary glands show diversehistological variation. There are limited data on major salivary gland tumor management and outcome fromPakistan. The objective of this study was to share our experience with management of malignant tumors ofmajor salivary glands. Materials and
Methods: Patients who received treatment at Shaukat Khanum CancerHospital and Research Center from July 2002 to June 2011 with an underlying diagnosis of a major salivarygland malignancy were included. Patient characteristics and treatment modalities were assessed. Local, regionaland distant failures were determined. Disease free survival (DFS) and overall survival (OS) were calculatedusing Kaplan Meier curves and the Log rank test was used to determine statistical significance. Univariate andmultivariate analyses were performed using Cox proportional hazard regression.
Results: The parotid glandwas the primary site of origin in 104 (80%) patients. Mucoepidermoid carcinoma (43%) and adenoid cysticcarcinoma (24%) were the most common histological types. Surgery followed by adjuvant radiation remained themainstay treatment modality with 81 (62%) patients. Nineteen (15%) patients were treated with surgery aloneand 30 (23%) patients with locally advanced surgically inoperable tumors received radiation only. Forty one(32%) patients failed the treatment (local 12, regional 11, locoregional 5, distant 13). The expected 5 year DFSand OS were 65% and 74% respectively. On multivariate analysis, grade was the only independent predictorof DFS and nodal involvement was the only independent predictor of overall survival.
Conclusions: Employingexisting standards of treatment, comparable survival can be achieved in Pakistani population with major salivarygland malignancies as elsehwere in the world.