Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer.

Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. 4 Laryngoscope, 134:3620-3632, 2024.

Patel AM ，Haleem A ，Maxwell R ，Lukens JN ，Lin A ，Brody RM ，Brant JA ，Carey RM ... -  《-》

Choice of Adjuvant Radiotherapy Facility in Sinonasal Squamous Cell Carcinoma.

Kaki PC ，Patel AM ，Maxwell R ，Brant JA ，Brody RM ，Adappa ND ，Palmer JN ，Douglas JE ，Carey RM ... -  《-》

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer.

To investigate adjuvant therapy indications, utilization, and associated survival disparities in major salivary gland cancer (MSGC). Retrospective cohort study. The 2006 to 2017 National Cancer Database. Patients with surgically resected MSGC were included (N = 11,398). pT3-4 classification, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and positive surgical margin (PSM) were considered indications for adjuvant radiotherapy (aRT). pENE and PSM were considered possible indications for adjuvant chemotherapy. Multivariable logistic and Cox regression models were implemented. Among 6694 patients with ≥ $<!--<semantics>-->\ge <!--</semantics>-->$ 1 indication for aRT, 1906 (28.5%) received no further treatment and missed aRT. Age, race, comorbidity status, facility type, and distance to reporting facility were associated with missed aRT (P < .025). Among 4003 patients with ≥1 possible indication for adjuvant chemoradiotherapy (aCRT), 914 (22.8%) received aCRT. Patients with pENE only (38.5%) and both pENE and PSM (44.0%) received aCRT more frequently than those with PSM only (17.0%) (P < .001). Academic facility was associated with aCRT utilization (P < .05). aCRT utilization increased between 2006 and 2017 in both academic (14.8% vs 23.9%) and nonacademic (8.8% vs 13.5%) facilities (P < .05). Among 2691 patients with ≥1 indication for aRT alone, missed aRT portended poorer OS (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.28-2.03, P < .001). Among 4003 patients with ≥1 possible indication for aCRT, aRT alone (HR: 1.02, 95% CI: 0.89-1.18, P = .780) and aCRT were associated with similar OS. Missed aRT in MSGC occurs frequently and portends poorer OS. Further studies clarifying indications for aCRT are required.

Patel AM ，Haleem A ，Choudhry HS ，Povolotskiy R ，Roden DF ... -  《-》

Impact of treating facilities' type and volume in patients with major salivary gland cancer.

Investigate the relationship between facility volume and type on overall survival (OS) in patients with major salivary gland cancer undergoing surgical treatment. Retrospective review of the National Cancer Database (NCDB) 2004-2015. The NCDB was queried for patients with surgically treated major salivary gland cancer. The mean number of cases treated at each institution was calculated. High-volume facilities (HVFs) were defined as the top 10% of centers. Univariate and multivariate propensity score-matched analyses were performed to evaluate the impact of facility volume and type on OS. A total of 8,658 patients were analyzed. Distribution among facilities was highly skewed, with a median value of 1.38 cases/year (range, 0.11-23.25). On univariate analysis, treatment at HVFs was not associated with improved OS. However, there were significantly more patients with adverse clinical features treated at HVFs. Treatment at HVFs was associated with increased rates of concomitant neck dissections and lower rates of positive margins. In propensity-score matched cohorts, OS was not significantly improved in patients treated at HVFs (hazard ratio [HR]: 0.979; 95% confidence interval [CI]: 0.879-1.091) or academic/research institutions (HR: 0.914; 95% CI: 0.821-1.018). Regionalization of care is occurring in patients with major salivary gland malignancies. Patients treated at HVFs had greater rates of adverse clinical features and more commonly underwent neck dissections, although adjuvant radiotherapy rates were similar between facility types. There was no apparent survival benefit to patients treated at HVFs or academic/research institutions, although there were lower rates of positive margins at HVF. NA Laryngoscope, 129:2321-2327, 2019.

Bollig CA ，Zitsch RP 3rd 《-》

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer.

To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC). Retrospective cohort study. The 2004 to 2019 National Cancer Database. The NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan-Meier and Cox survival analyses. Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment (P < 0.025). Patients with positive surgical margins (PSM) had higher 5-year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5-year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37-0.84) was associated with higher OS than definitive RT or CRT (P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80-1.29, P = 0.896) tumors had similar OS. A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.

Patel AM ，Haleem A ，Choudhry HS ，Brant JA ，Brody RM ，Carey RM ... -  《-》