Prognostic factors in salvage surgery for recurrent salivary gland carcinoma / Fatores prognósticos em carcinomas de glândulas salivares recidivados submetidos à cirurgia de resgate

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Salivary gland carcinomas are rare and the main treatment option is surgery with or without postoperative radiotherapy. Almost half of the cases present recurrences of tumors and the majority are local. The only potentially curative treatment for recurrent tumors is salvage surgery. However, few papers were published on this subject. The aim of this study is evaluate the surgical complications and clinical and pathologic prognostic factors in patients with recurrent salivary gland carcinoma submitted to salvage surgery. We reviewed the medical charts of 59 patients that fulfilled the eligibility critera of the study: proven diagnosis of locorregionally recurrent salivary gland carcinoma and surgery with curative intention. Thirty five patients (59,3%) had been previously treated at another institution. The salvage surgery in all the patients was performed at the A. C. Camargo Hospital in São Paulo, Brazil from 1957 to 2000. The site of the primary tumor was the parotid in 34 cases, the oral cavity in 13 and submandibular gland in 12 cases. The most frequent histopathologic type was adenoid cystic carcinoma (23 cases; 39%) and mucoepidermoid carcinoma (14 cases ;23.7%). The prior treatment was surgery alone in 47 cases, surgery with adjuvant radiotherapy in 11 cases and surgery and adjuvant chemotherapy in only one case. The majority of the patients presented local recurrence (39; 66%), in seven cases the recurrence was regional (11.9%) and in thirteen cases it was locorregional (22.1%). The clinical stage of the recurrences were initial (rCS I/II) in 15 patients (25.5%) and advanced (rCS III/IV) in 44 patients (74.5%). The surgical treatment of the recurrence was local ressection in 39 cases (66.1%), en bloc surgeries (local ressection and neck dissection) in thirteen cases (22%) and neck dissection alone in seven cases (11.9%). Wide parotidectomy with temporal bone ressection was performed in five cases. The overall rate of surgical complications was 32.2%. The most frequent complication was wound infection. There was no post-operative deaths. There was a new recurrence in 61% of the patients, and the majority were distant metastases (16 cases; 27%). The lung was the most frequent involved site. In ten cases (17%) the recurrence was local, in five cases it was locorregional (8.5%). The actuarial overall survival were 61.3% in 5 years and 42% in ten years and in five cases it was regional (8.5%). Gender, histopathology, site of the primary tumor, facial nerve preservation (parotid tumors), were not associated with overall survival. In the univariate analysis, only age older than 60 years was associate with a poor prognosis. This study shows that the prognosis of patients with recurrent salivary gland carcinoma treated to salvage surgery is acceptable. The rates of surgical complications are local and there was no post-operative mortality in this series.

ASSUNTO(S)

neoplasias das glândulas salivares/complicações recidiva salivary gland neoplasms/complications salivary gland neoplasms/surgery prognóstico neoplasias das glândulas salivares/cirurgia prognosis recurrence

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