SALIVARY-GLAND-CANCER
May 26th, 2008 by admin
I will begin by stating that I am a student of the disease at hand and by no
>means an expert. But allow me to bemoan my struggles with the literature
>concerning adenoid cystic carcinoma and some of my most gut wrenching tumor
>boards.
>
>So now I preach to the choir.
>
>I will look forward to reviewing a couple of these articles which I have not
>already read. A few are familiar and point to a few problems which nag me at
>every tumor board I go to concerning adenoid cystic carcinoma of minor
>salivary origin.
>
>The first thing I look at in articles about adenoid cystic carcinoma is
>whether or not they took into account the advent of polymorphous low-grade
>carcinoma in the 1980’s. Trying to find what is “clean” data, has been
>nearly impossible. I will relish the first article that specifically
>accounts for polymorphous low-grade adenocarcinoma and realizes that this
>now common diagnosis was often pigeonholed as adenoid cystic carcinoma prior
>to the mid-1980’s. Certainly polymorphous low-grade adenocarcinoma’s
>behavior could drastically skew any data in which they were intermixed with
>biometric data from adenoid cystic carcinoma. Most data is suspect in my
>mind for this reason. (ref for PLGA interpretation and biometrics is at end
>of message) My gut instinct is that adenoid cystic carcinoma of minor
>salivary glands may be an even worse actor than we give it credit for. I
>also wonder whether data taken from major gland disease or co-mingled with
>data thereof confounds the issue of radiation.
>
>The local control of adenoid cystic carcinoma with radiation has some better
>data. But then I’m always drawn to what the long-term outcome is and still
>come up with the dismal longterm prognosis. Even then, finding articles
>which specifically state the difference between local control vs. metastases
>and survival can be a challenge.
>
>To date the tumor boards I’ve been associated with have recommended
>radiation and surgery in 5 of 5 cases of minor salivary gland adenoid cystic
>carcinoma. 4 of 5 patients elected to have radiation following surgery. As I
>see the patients deal with the salivary, dental and osseous, post-radiation
>sequelae, I always wonder. If I have to keep telling them the quantitative
>survival is no better, it’d be nice to tell them the qualitative survival is
>better. I sure wish I had some science to give me a better warm and fuzzy
>that decreasing the local recurrences was better than a second surgery if a
>recurrence ensued. But until then….
>
>
>TITLE: Polymorphous low grade adenocarcinoma: a clinicopathologic study of
>164 cases.
>AUTHORS: Castle JT; Thompson LD; Frommelt RA; Wenig BM; Kessler HP
>AUTHOR AFFILIATION: Department of Oral and Maxillofacial Pathology, Armed
>Forces Institute of Pathology,
>SOURCE: Cancer 1999 Jul 15;86(2):207-19.
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