The protective role of postoperative radiation therapy in low and intermediate grade major salivary gland malignancies: A study of the Canadian Head and Neck Collaborative Research Initiative
Grégoire B. Morand, Antoine Eskander, Rui Fu, John R. de Almeida, David P. Goldstein, Hesameddin Noroozi, Ali Hosni, Hadi Seikaly, Paul Tabet, Justin M. Pyne, T. Wayne Matthews, Joseph C. Dort, Steve Nakoneshny, Apostolos Christopoulos, Houda Bahig, Stephanie Johnson‐Obaseki, Nadia Hua, Marc Gaudet, Alborz Jooya, Anthony C. Nichols, Francisco Laxague, Matthew J. Cecchini, Jenny Du, Justin Shapiro, Irene Karam, Peter T. Dziegielewski, Krishna S. Hanubal, Boban M. Erović, Stefan Grasl, Joel Davies, Eric Monteiro, Maru Gete, Ian Witterick, Nader Sadeghi, Keith Richardson, George Shenouda, Anastasios Maniakas, Vivianne Landry, Michael K. Gupta, Kelvin Zhou, Alex Mlynarek, Marc Pusztaszeri, Khalil Sultanem, Michael P. Hier
Abstract
BACKGROUND: The objective of this study was to examine the utility of postoperative radiation for low and intermediate grade cancers of the parotid and submandibular glands. METHODS: The authors conducted a retrospective, Canadian-led, international, multi-institutional analysis of a patient cohort with low or intermediate grade salivary gland cancer of the parotid or submandibular gland who were treated from 2010 until 2020 with or without postoperative radiation therapy. A multivariable, marginal Cox proportional hazards regression analysis was performed to quantify the association between locoregional recurrence (LRR) and receipt of postoperative radiation therapy while accounting for patient-level factors and the clustering of patients by institution. RESULTS: In total, 621 patients across 14 tertiary care centers were included in the study; of these, 309 patients (49.8%) received postoperative radiation therapy. Tumor histologies included 182 (29.3%) acinic cell carcinomas, 312 (50.2%) mucoepidermoid carcinomas, and 137 (20.5%) other low or intermediate grade primary salivary gland carcinomas. Kaplan-Meier LRR-free survival at 10 years was 89.0% (95% confidence interval [CI], 84.9%-93.3%). In multivariable Cox regression analysis, postoperative radiation therapy was independently associated with a lower hazard of LRR (adjusted hazard ratio, 0.53; 95% CI, 0.29-0.97). The multivariable model estimated that the marginal probability of LRR within 10 years was 15.4% without radiation and 8.8% with radiation. The number needed to treat was 16 patients (95% CI, 14-18 patients). Radiation therapy had no benefit in patients who had early stage, low-grade salivary gland cancer without evidence of nodal disease and negative margins. CONCLUSIONS: Postoperative radiation therapy may reduce LLR in some low and intermediate grade salivary gland cancers with adverse features, but it had no benefit in patients who had early stage, low-grade salivary gland cancer with negative margins.