TITLE:
Salivary Gland Tumors: Randomized Study of Adjuvant Chemo-Radiotherapy versus Radiotherapy Alone
AUTHORS:
Tarek Shouman, Azza Niazy Taher, Amany Helal, Ahmed Charaf
KEYWORDS:
Salivary gland Tumors, Chemoradiation, Radiosensitizer, Cisplatin, Adenoid Cystic Tumors, Mucoepidermoid
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.12 No.10,
October
18,
2021
ABSTRACT: Objective: Concurrent chemoradiation value of the resected salivary tumor adjuvant
context against regular radiation therapy alone. Design: Prospective
randomized clinical trial. Patients: 48 patients were randomized to
either adjuvant postoperative radiology alone versus concurrent
chemoradiotherapy (weekly cisplatin 40 mg/m2 for 6 cycles) “with
resected high-risk salivary tumors of the large and minor salivary gland”. Main Outcome Measures: Recurrent locoregional Free survival, distant
free survival, and overall survival. Results: Out of the 48 participants
in the study 31 patients had parotid gland tumors. 23 patients received solely
adjuvant radiation while 25 patients received concurrent chemoradiotherapy. In
the chemoradiation group, platinum-based regimens were employed in all. The mean
age in both groups was 48 years. Adenoid cystic carcinoma was the primary
pathogenic form of both arms 56% (28 cases). Stage II patients were 35% and
32%, stage III was 39% and 48% and stage VIa were 26% and 20% in the radiation
arm and chemoradiotherapy arm respectively. 40 of 48 patients (83%) had close
or positive surgical margins and 30 of 48 patients (62%) have a perineural
invasion. Both risk variables are more or less well balanced in both arms with
no statistical difference. The 2- and 4-year estimates of the locoregional
recurrence-free survival rate in the chemoradiation group were 95% and 73%,
compared to 77.4% and 43.6% in the radiation arm respectively (p = 007). In the
two-and four-year-old chemoradiation arm distant free metastases were 100% and
59% compared to 68% and 39% respectively in the radiation arm (p = 0.08). The
overall survival estimates for 2 and 4 years were 93% and 78% respectively in
the Chemoradiation Group but in the radiation-alone group were 95% and 48%
respectively. The statistically significant differences were p = 0.009 by
log-rank testing. Treatment was generally tolerated, although, in the
chemoradiation group adverse symptoms, mainly mucositis increased. Conclusions: Adding weekly cisplatin as a radiosensitizer for locally advanced stage or
high-grade salivary gland cancer with adjuvant conventional radiation looks to
be helpful and justifies further exploration in selected patients.