Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma.

Autor:	Sajisevi M; Division of Otolaryngology, University of Vermont Medical Center, Burlington., Nguyen K; Robert Larner College of Medicine, University of Vermont, Burlington., Callas P; Robert Larner College of Medicine, University of Vermont, Burlington., Holcomb AJ; Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha., Vural E; Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock., Davis KP; Department of Otolaryngology, St Louis University School of Medicine, St Louis, Missouri., Thomas CM; Department of Otolaryngology, University of Alabama at Birmingham., Plonowska-Hirschfeld KA; Department of Otolaryngology, University of California, San Francisco., Stein JS; Department of Otolaryngology, University of Alabama at Birmingham., Eskander A; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada., Kakarala K; Department of Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City., Enepekides DJ; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada., Hier MP; Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada., Ryan WR; Department of Otolaryngology, University of California, San Francisco., Asarkar AA; Department of Otolaryngology/Head & Neck Surgery, Ochsner-LSU Health, Shreveport, Louisiana., Aulet R; Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts., Bell RK; Geisel School of Medicine at Dartmouth, Section of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire., Blasco MA; Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell, Northwell Health Cancer Institute, New York, New York., Bowmaster VB; University of Nebraska College of Medicine, Omaha., Burruss CP; University of Kentucky, Department of Otolaryngology-Head and Neck Surgery, Lexington., Chung J; Department of Otolaryngology-Head & Neck Surgery, West Virginia University, Morgantown., Chan K; Department of Otolaryngology Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania., Chang BA; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic Arizona, Phoenix., Coffey CS; Department of Otolaryngology/Head & Neck Surgery, University of California San Diego School of Medicine., Cognetti DM; Department of Otolaryngology-Head & Neck Surgery, Sidney Kimmel Medical College/Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania., Cooper DJ; Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell, Northwell Health Cancer Institute, New York, New York., Cordero J; Department of Otolaryngology and Head & Neck Surgery, Texas Tech University - Health Sciences Center, Lubbock., Donovan J; Salem Hospital, Salem, Oregon., Du YJ; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Dundar Y; Department of Otolaryngology and Head & Neck Surgery, Texas Tech University - Health Sciences Center, Lubbock., Dedivitis RA; Department of Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil., Edwards HA; Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts., Erovic BM; Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria., Feinberg PA; Medical Scientist Training Program, UMass Chan Medical School, Worcester, Massachusetts., Garvey EA; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Goldstein DP; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada., Goodman JF; Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC., Goulart RN; Hospital Governador Celso Ramos, Florianopolis, Brazil., Goyal N; Department of Otolaryngology Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania., Grasl S; Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Giurintano JP; Department of Otolaryngology, Georgetown, Washington, DC., Gupta N; University of Kentucky, Department of Otolaryngology-Head and Neck Surgery, Lexington., Habib AM; Department of Otolaryngology, Georgetown, Washington, DC., Hackman TG; Department of Otolaryngology/Head & Neck Surgery, The University of North Carolina at Chapel Hill., Hara JH; Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois., Henson C; Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City., Hinni ML; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic Arizona, Phoenix., Hua N; Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada., Johnson-Obaseki S; Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada., Juloori A; Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois., Kalman NS; Miami Cancer Institute, Baptist Health South Florida and the Herbert Wertheim College of Medicine, Florida International University, Miami., Kejner AE; Department of Otolaryngology, Medical University of South Carolina, Charleston., Khaja SF; Department of Otolaryngology, University of Minnesota, Minneapolis., Ku JA; Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Lambert A; Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada., Luu BK; Department of Otolaryngology/Head & Neck Surgery, University of California San Diego School of Medicine., Magliocca KR; Department of Pathology and Laboratory Medicine, Winship Cancer Institute at Emory University, Atlanta, Georgia., Dos Santos LRM; Hospital Governador Celso Ramos, Florianopolis, Brazil., Michael C; Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts., Miles BA; Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell, Northwell Health Cancer Institute, New York, New York., de Melo GM; Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil.; Department of Head and Neck Surgery, Beneficência Portuguesa of São Paulo Hospital, São Paulo, Brazil., Moore MG; Department of Otolaryngology, University of Indiana, Indianapolis, Indiana., Morand GB; Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada., Moura K; Department of Head and Neck Surgery, Santa Casa de Misericórdia de Santos, Santos, Brazil., Mukdad L; Department of Otolaryngology, University of California, Los Angeles., Noroozi H; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada., Patel R; Department of Otolaryngology, University of Oklahoma, Oklahoma City., Paydarfar JA; Geisel School of Medicine at Dartmouth, Section of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire., Sadeghi N; Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Québec, Canada., Savaria FN; Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St Gallen, St Gallen, Switzerland., Schmitt NC; Department of Otolaryngology, Winship Cancer Institute at Emory University, Atlanta, Georgia., Shapiro J; Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada., Shaver TB; Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC., Stoeckli SJ; Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St Gallen, St Gallen, Switzerland., St John M; Department of Otolaryngology, University of California, Los Angeles., Stokes WA; Department of Otolaryngology-Head & Neck Surgery, West Virginia University, Morgantown., Sulibhavi A; Department of Otolaryngology, Temple University Hospital, Philadelphia, Pennsylvania., Tasoulas J; Department of Otolaryngology/Head & Neck Surgery, The University of North Carolina at Chapel Hill., Vendra V; Department of Otolaryngology, Temple University Hospital, Philadelphia, Pennsylvania., Vinh DB; Department of Otolaryngology, University of Indiana, Indianapolis, Indiana., Virgen CG; Department of Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City., Wooten C; Department of Otolaryngology, University of California, Los Angeles., Woody NM; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Young GD; Miami Cancer Institute, Baptist Health South Florida and the Herbert Wertheim College of Medicine, Florida International University, Miami.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2024 Feb 01; Vol. 150 (2), pp. 107-116.
DOI:	10.1001/jamaoto.2023.3952
Abstrakt:	Importance: Postoperative radiation therapy for close surgical margins in low- to intermediate-grade salivary carcinomas lacks multi-institutional supportive evidence. Objective: To evaluate the oncologic outcomes for low- and intermediate-grade salivary carcinomas with close and positive margins. Design, Setting, and Participants: The American Head and Neck Society Salivary Gland Section conducted a retrospective cohort study from 2010 to 2019 at 41 centers. Margins were classified as R0 (negative), R1 (microscopically positive), or R2 (macroscopically positive). R0 margins were subclassified into clear (>1 mm) or close (≤1 mm). Data analysis was performed from June to October 2023. Main Outcomes and Measures: Main outcomes were risk factors for local recurrence. Results: A total of 865 patients (median [IQR] age at surgery, 56 [43-66] years; 553 female individuals [64%] and 312 male individuals [36%]) were included. Of these, 801 (93%) had parotid carcinoma and 64 (7%) had submandibular gland carcinoma, and 748 (86%) had low-grade tumors and 117 (14%) had intermediate-grade tumors, with the following surgical margins: R0 in 673 (78%), R1 in 168 (19%), and R2 in 24 (3%). Close margins were found in 395 of 499 patients with R0 margins (79%), for whom margin distances were measured. A total of 305 patients (35%) underwent postoperative radiation therapy. Of all 865 patients, 35 (4%) had local recurrence with a median (IQR) follow-up of 35.3 (13.9-59.1) months. In patients with close margins as the sole risk factor for recurrence, the local recurrence rates were similar between those who underwent postoperative radiation therapy (0 of 46) or observation (4 of 165 [2%]). Patients with clear margins (n = 104) had no recurrences. The local recurrence rate in patients with R1 or R2 margins was better in those irradiated (2 of 128 [2%]) compared to observed (13 of 64 [20%]) (hazard ratio [HR], 0.05; 95% CI, 0.01-0.24). Multivariable analysis for local recurrence found the following independent factors: age at diagnosis (HR for a 10-year increase in age, 1.33; 95% CI, 1.06-1.67), R1 vs R0 (HR, 5.21; 95% CI, 2.58-10.54), lymphovascular invasion (HR, 4.47; 95% CI, 1.43-13.99), and postoperative radiation therapy (HR, 0.10; 95% CI, 0.04-0.29). The 3-year local recurrence-free survivals for the study population were 96% vs 97% in the close margin group. Conclusions and Relevance: In this cohort study of patients with low- and intermediate-grade major salivary gland carcinoma, postoperative radiation therapy for positive margins was associated with decreased risk of local recurrence. In isolation from other risk factors for local recurrence, select patients with close surgical margins (≤1 mm) may safely be considered for observation.
Databáze:	MEDLINE
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