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Omission of radiotherapy to lymph node level III in patients with cN0 adenoid cystic carcinoma of the major salivary gland: a single center experience

  • Radiotherapy
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Abstract

Purpose

Due to the rarity of adenoid cystic carcinoma (ACC) of the major salivary gland, there is no consensus on the extent of prophylactic neck irradiation (PNI) for patients with clinically negative lymph nodes (cN0) disease.

Materials and methods

We conducted a retrospective analysis of all patients with ACC of the major salivary gland who received treatment at our center between January 2010 and April 2020. The primary endpoint was regional failure-free survival (RRFS). Secondary endpoints included overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), and acute toxicity.

Results

A total of 139 patients were included in the analysis. For cN0 patients, the 5-year RRFS, OS, DMFS, and LRFS were 93.2%, 90.2%, 75.7%, and 91.4%, respectively. Multivariate analysis revealed that PORT was an independent prognostic factor for RRFS and LRFS. No statistically significant differences were observed between the Level III sparing PNI group and the Standard PNI group in terms of RRFS, OS, DMFS, and LRFS. The doses delivered to the larynx and thyroid in the Level III sparing PNI group were significantly lower than those in the Standard PNI group.

Conclusion

In patients with cN0 ACC of the major salivary gland, PNI improves regional control, and the level III nodal region sparing radiotherapy does not increase the risk of level III recurrence, while potentially reducing toxicity.

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Data sharing statement

All relevant data were uploaded onto the Research Data Deposit public platform (www.researchdata.org.cn).

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Funding

The authors declare that they have no funding.

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Author notes

  1. Zichen Qiu and Zheng Wu have contributed equally to this study.

Authors and Affiliations

  1. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People’s Republic of China

    Zichen Qiu, Xiong Zhou, Yalan Tao & Yong Su

  2. Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283 Tong Zi Po Road, Changsha, 410013, People’s Republic of China

    Zheng Wu

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  1. Zichen Qiu
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Contributions

ZQ YS: conception and design; ZQ XZ data collection; ZQ ZW: statistical analysis; ZQ ZW: manuscript preparation; YT YS: quality control of data and manuscript review; All authors read and approved the final manuscript. The name and email address of the author responsible for statistical analysis: Qiu Zichen: qiuzc@sysucc.org.cn.

Corresponding authors

Correspondence to Yalan Tao or Yong Su.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was approved by the Medical Ethics Committee of Affiliated Hospital of Sun Yat-sen University Cancer Center with the approval number B2022-023-01, and the need for written informed consent was waived.

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Qiu, Z., Wu, Z., Zhou, X. et al. Omission of radiotherapy to lymph node level III in patients with cN0 adenoid cystic carcinoma of the major salivary gland: a single center experience. Radiol med 129, 335–345 (2024). https://doi.org/10.1007/s11547-024-01763-5

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  • DOI: https://doi.org/10.1007/s11547-024-01763-5

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