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Original Investigation |

Association of Adjuvant Chemoradiotherapy vs Radiotherapy Alone With Survival in Patients With Resected Major Salivary Gland Carcinoma Data From the National Cancer Data Base ONLINE FIRST

Arya Amini, MD1; Timothy V. Waxweiler, MD1; Jeffrey V. Brower, MD, PhD2; Bernard L. Jones, PhD1; Jessica D. McDermott, MD3,4; David Raben, MD1; Debashis Ghosh, PhD5; Daniel W. Bowles, MD3,4; Sana D. Karam, MD, PhD1
[+] Author Affiliations
1Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
2Department of Human Oncology, Carbone Cancer Center, School of Medicine, University of Wisconsin, Madison
3Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora
4Division of Medical Oncology, Department of Medicine, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver
5Department of Biostatistics, University of Colorado School of Medicine, Aurora
JAMA Otolaryngol Head Neck Surg. Published online August 18, 2016. doi:10.1001/jamaoto.2016.2168
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Importance  Data on adjuvant concurrent chemoradiotherapy (CRT) after resection of salivary gland carcinomas (SGCs) are limited.

Objective  To examine overall survival (OS) outcomes of patients who receive CRT vs radiotherapy (RT) alone after resection of SGCs.

Design, Setting, and Participants  The National Cancer Data Base (NCDB), a hospital-based registry that represents 70% of all cancer cases in the United States, was queried for patients who underwent resection of major SGCs with at least 1 high-risk feature (T3-T4 stage, N1-N3 stage, or positive margins). Included patients had histologic findings for malignant SGC with grades 2 to 3 disease and at least 1 high-risk feature. All patients underwent resection with postoperative CRT or RT alone. Patients were treated from 1998 to 2011. Data were analyzed from January to March 2016.

Exposures  Patients received CRT, defined as chemotherapy start within 14 days of RT initiation, or RT alone.

Main Outcomes and Measures  Univariate, multivariate, and propensity score–matched analyses were performed to compare OS for patients undergoing CRT vs RT alone.

Results  Analyses included 2210 eligible patients (1372 men [62.1%] and 838 women [37.9%]; median age [range], 63 [18-90] years); of these, 1842 (83.3%) received RT alone and 368 (16.7%) received CRT. Median follow-up was 39 (range, 2-188) months. Most of the resected major SGCs occurred at the parotid gland (1852 [83.8%]), followed by the submandibular gland (276 [12.5%]), major gland not otherwise specified (66 [3.0%]), and sublingual gland (16 [0.7%]). Unadjusted 2-year OS was worse with adjuvant CRT vs RT alone (71.3% vs 80.2%), as was 5-year OS (38.5% vs 54.2%) (hazard ratio [HR], 1.51; 95% CI, 1.29-1.76; P < .001). Overall survival was inferior with adjuvant CRT on multivariate analysis (HR, 1.22; 95% CI, 1.03-1.44; P = .02) and propensity score–matched analysis (HR, 1.20; 95% CI, 0.98-1.47; P = .08) compared with RT alone. Subgroup analyses by age, comorbidity score, primary site, histologic type, grade, T stage, N stage, margin status, and chemotherapy (single agent vs multiagent) demonstrated equivalent or shorter OS with the addition of chemotherapy to RT.

Conclusions and Relevance  This large analysis compared survival outcomes between postoperative CRT and RT alone in patients undergoing resection of high-risk major SGCs using a nationally representative database. The addition of concurrent chemotherapy to RT in patients with high-risk major SGCs did not offer an advantage in OS.

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Figure 1.
Case Selection for the Study Cohort

Data were obtained from the National Cancer Data Base (NCDB). CRT indicates chemoradiotherapy; RT, radiotherapy;and SGC, salivary gland carcinoma.

aIncludes mucoepidermoid carcinoma, adenoid cystic carcinoma, adenocarcinoma, salivary duct carcinoma, and acinic cell carcinoma.

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Figure 2.
Kaplan-Meier Curves of Overall Survival

Patients underwent radiotherapy (RT) alone or concurrent chemoradiotherapy (CRT) after resection of major salivary gland carcinoma. HR indicates hazard ratio.

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