Adding concurrent chemotherapy to postoperative radiotherapy improves locoregional control but Not overall survival in patients with salivary gland adenoid cystic carcinoma—a propensity score matched study

摘要

Purpose To compare the long-term outcomes in patients with salivary gland adenoid cystic carcinoma (SGACC) treated with post-operative chemoradiotherapy (POCRT) versus post-operative radiotherapy (PORT). Methods We retrospectively reviewed the records of 91 SGACC patients treated with surgery followed by PORT ( n =?58) or POCRT ( n =?33) between 2000 and 2013. Treatment outcomes between groups were compared using propensity score matching (1:1 nearest neighbor). Results The median radiation dose was 66?Gy, and patients were followed up for a median of 71?months. Cisplatin-based concurrent regimens were the most commonly used chemotherapy schedules. In the entire study cohort, patients undergoing POCRT showed a trend toward higher locoregional control (LRC) rates than those treated with PORT alone at both 5 and 8?years (97 and 97?% versus 84 and 79?%, respectively; P =?.066). Distant metastases were the most common form of treatment failure and occurred in 31 (34?%) patients (PORT, n =?17; POCRT, n =?14). After propensity score matching (33 pairs), patients receiving POCRT had 5- and 8?year LRC rates of 97 and 97?%, respectively, compared with 79 and 67?% for patients treated with PORT alone ( P =?.017). The two groups did not differ significantly in terms of distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). However, a significantly better opioid-requiring pain-free survival (ORPFS) was achieved in POCRT group ( P =?.038). Subgroup analyses revealed that patients with stage III???IV disease ( P =?.040 and .017), positive surgical margins ( P =?.011 and .050), or perineural invasion ( P =?.013 and .035) had significantly higher 5- and 8?year LRC and ORPFS when treated with POCRT, respectively. Conclusions In SGACC patients, adding concurrent chemotherapy to PORT may increase LRC and ORPFS rates, particularly in presence of stage III???IV disease, positive surgical margins, or perineural invasion. However, no significant differences in DMFS, DFS, and OS were observed.