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Early T Stage Salivary Duct Carcinoma: Outcomes and Implications
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International Journal of Radiation Oncology Biology Physics
comparison of FAK expression in central cells of recurrent and nonrecurrent cases of ameloblastoma (PZ.3692) was found to be insignificant. Conclusion: FAK expression in odontogenic epithelium of ameloblastoma suggests its role in the locally aggressive behavior. FAK could be responsible for cell invasion and migration in ameloblastoma. Author Disclosure: S.M. Patil: None.
with surgery alone (16%), surgery + XRT (45%), and surgery + cXRT (39%). On multivariate regression the only variables found to be significantly associated with overall survival were cutaneous primary >2 cm (PZ.03) and ECS (PZ.01). Location of regional metastasis (neck vs parotid vs both) had no effect on overall survival (PZ.2). Survival was also unaffected by the presence of a cutaneous primary at the time of presentation (PZ.9). Overall survival at 5 years was 59% with a 51% rate of recurrence. Conclusion: Regionally metastatic cHNSCC is an uncommon but aggressive disease associated with high recurrence rates. Patients with tumors >2 cm and ECS have poorer overall survival despite adjuvant therapy. Author Disclosure: M. Amoils: None. C.S. Lee: Junior Board member; Western Orthopedic Association. J. Sunwoo: None. S.Z. Aasi: None. W. Hara: None. J. Kim: None. D. Sirjani: None. A.D. Colevas: Committee member; AJCC. Panel member; NCCN. Board Member; ANCO. A.L. Chang: None. V. Divi: None.
314 Early T Stage Salivary Duct Carcinoma: Outcomes and Implications A. Sharma,1 N.C. Schmitt,2 M.R. Gilbert,3 and S. Kim4; 1Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University, Springfield, IL, 2Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 3Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 4University of Pittsburgh Medical Center, Pittsburgh, PA Purpose/Objective(s): Salivary duct carcinoma (SDC) is a rare salivary malignancy that often presents at advanced stage. However, some patients are diagnosed early; the objective of this study is to describe the clinicopathologic presentation and survival outcomes of early T stage (Tis, T1, and T2) SDC. Materials/Methods: A single institution’s head and neck pathology database was reviewed for all cases of histopathologically diagnosed early T stage SDC between January 1995 and October 2014. We reviewed the electronic medical record to determine patient demographics, tumor data, treatment, and outcome, including disease-free and overall survival (DFS and OS, respectively). Results: Twenty-eight patients with early T stage SDC were identified. Most tumors (75%) were in the parotid gland. All patients underwent surgical resection, and 64% underwent neck dissection as well. Most patients (71%) received adjuvant treatment. Perineural, vascular, and extracapsular invasion were associated with N stage. Median DFS and OS were 3.2 and 4.7 years, respectively. Parotid primary site, vascular invasion, extracapsular invasion, and facial nerve sacrifice were associated with worse survival. Adjuvant therapy was not associated with survival. Conclusion: Early T stage SDC is an aggressive malignancy with median DFS of 3.2 years and median OS of 4.7 years. Predictors of survival include primary site, vascular invasion, facial nerve sacrifice, and extracapsular invasion. Despite low T stage and aggressive treatment, prognosis is poor for these patients. Author Disclosure: A. Sharma: None. N.C. Schmitt: None. M.R. Gilbert: None. S. Kim: None.
315 Regionally Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck: Survival and High-Risk Features M. Amoils,1 C.S. Lee,2 J. Sunwoo,2 S.Z. Aasi,2 W. Hara,3 J. Kim,2 D. Sirjani,2 A.D. Colevas,3 A.L.S. Chang,2 and V. Divi3; 1Stanford Otolaryngology, Stanford, CA, 2Stanford, Stanford, CA, 3Stanford University, Stanford, CA Purpose/Objective(s): To describe treatment outcomes and clinicopathologic correlates for patients treated for regionally metastatic cutaneous squamous cell carcinoma of the head and neck (cHNSCC). Materials/Methods: The study design was a retrospective chart review. CPT and ICD-9 codes were used to identify patients treated for regionally metastatic cHNSCC at our institution. Charts were reviewed to ensure appropriate inclusion and extract demographics, clinicopathologic information, and survival outcomes. The effect of various clinicopathologic variables on overall survival was investigated with a Cox analysis. KaplanMeier survival curves were constructed and compared with the log-rank test. Results: Eighty patients were included with a mean age of 73 years (standard deviation 11.5). The majority presented with recurrent disease (66%). The most common high-risk tumor features were perineural invasion (41%) and extracapsular spread (ECS) (31%). Patients were treated
316 Outcomes and Patterns of Failure for Sinonasal Undifferentiated Carcinoma (SNUC): The Mayo Clinic Experience M.E. Gamez,1 D. Lal,2 M.Y. Halyard,1 W.W. Wong,2 C. Vargas,3 K. Curtis,1 S. Ko,4 R.L. Foote,5 and S.H. Patel1; 1Mayo Clinic, Scottsdale, AZ, 2Mayo Clinic, Phoenix, AZ, 3Mayo AZ, Phoenix, AZ, 4Mayo Clinic, Jacksonville, FL, 5Mayo Clinic, Rochester, MN Purpose/Objective(s): Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive disease arising in the nasal cavity and paranasal sinuses with often dismal outcomes and unclear optimal management. This study was performed to determine the outcomes and patterns of failure for SNUC at the Mayo Clinic. Materials/Methods: We identified for the present institutional review boardeapproved analysis a subset of 40 patients (pts) treated at the Mayo Clinic from 1990 to 2014. The median age at presentation was 56.7 years (range, 29-82). Twenty-four pts (60%) were male. The primary site was nasal cavity in 20 pts (50%) and ethmoid sinus in 10 pts (25%). The majority of the pts, 32 (80%), presented with T4 disease. Twenty-four pts (60%) received trimodality therapy in the form of chemotherapy, radiation therapy (RT), and surgery. Most pts (60%) were treated with intensity modulated RT, and 16 pts (40%) received total doses 60 Gy. The most frequent chemotherapy regimen utilized for the trimodality approach was cisplatin and etoposide in 11 pts (27.5%). Results: The median follow-up for surviving pts was 6.9 years (range, 1.117). A total of 16 pts (40%) experienced recurrent disease, 5 local recurrences (12.5%), 1 regional recurrence (2.5%), and 10 (25%) distant metastasis. The 5-year overall survival (OS), recurrence-free survival (RFS), and locoregional control (LRC) were 44%, 39%, and 71%, respectively. With respect to treatment modality, pts treated with multimodality therapy had improved OS, RFS, and LRC compared to pts treated with single modality therapy. Improved OS was noted in patients receiving intensity modulated RT and also in patients receiving 60 Gy. The most common cause of death was distant metastasis. Acute radiation toxicity was radiation dermatitis grade 1-2 (G1-2) (85%), mucositis G1-2 (60%), and fatigue (50%). Long-term toxicity included nasal dryness (30%), xerostomia (10%), retinopathy and optic neuropathy in (5%), and radionecrosis (2.5%). Conclusion: SNUC is an aggressive malignancy that frequently presents at a locally advanced stage with a high tendency to metastasize. The best outcomes in our series were obtained with a multimodality approach. Modern RT techniques and doses 60 Gy were associated with improved OS. Proton therapy may potentially further improve outcomes by allowing dose escalation with better sparing of normal organs. Optimal sequencing of multimodality therapy still needs to be defined. Author Disclosure: M.E. Gamez: None. D. Lal: None. M.Y. Halyard: None. W.W. Wong: None. C. Vargas: None. K. Curtis: None. S. Ko: None. R.L. Foote: None. S.H. Patel: None.
International Journal of Radiation Oncology Biology Physics
comparison of FAK expression in central cells of recurrent and nonrecurrent cases of ameloblastoma (PZ.3692) was found to be insignificant. Conclusion: FAK expression in odontogenic epithelium of ameloblastoma suggests its role in the locally aggressive behavior. FAK could be responsible for cell invasion and migration in ameloblastoma. Author Disclosure: S.M. Patil: None.
with surgery alone (16%), surgery + XRT (45%), and surgery + cXRT (39%). On multivariate regression the only variables found to be significantly associated with overall survival were cutaneous primary >2 cm (PZ.03) and ECS (PZ.01). Location of regional metastasis (neck vs parotid vs both) had no effect on overall survival (PZ.2). Survival was also unaffected by the presence of a cutaneous primary at the time of presentation (PZ.9). Overall survival at 5 years was 59% with a 51% rate of recurrence. Conclusion: Regionally metastatic cHNSCC is an uncommon but aggressive disease associated with high recurrence rates. Patients with tumors >2 cm and ECS have poorer overall survival despite adjuvant therapy. Author Disclosure: M. Amoils: None. C.S. Lee: Junior Board member; Western Orthopedic Association. J. Sunwoo: None. S.Z. Aasi: None. W. Hara: None. J. Kim: None. D. Sirjani: None. A.D. Colevas: Committee member; AJCC. Panel member; NCCN. Board Member; ANCO. A.L. Chang: None. V. Divi: None.
314 Early T Stage Salivary Duct Carcinoma: Outcomes and Implications A. Sharma,1 N.C. Schmitt,2 M.R. Gilbert,3 and S. Kim4; 1Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University, Springfield, IL, 2Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 3Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 4University of Pittsburgh Medical Center, Pittsburgh, PA Purpose/Objective(s): Salivary duct carcinoma (SDC) is a rare salivary malignancy that often presents at advanced stage. However, some patients are diagnosed early; the objective of this study is to describe the clinicopathologic presentation and survival outcomes of early T stage (Tis, T1, and T2) SDC. Materials/Methods: A single institution’s head and neck pathology database was reviewed for all cases of histopathologically diagnosed early T stage SDC between January 1995 and October 2014. We reviewed the electronic medical record to determine patient demographics, tumor data, treatment, and outcome, including disease-free and overall survival (DFS and OS, respectively). Results: Twenty-eight patients with early T stage SDC were identified. Most tumors (75%) were in the parotid gland. All patients underwent surgical resection, and 64% underwent neck dissection as well. Most patients (71%) received adjuvant treatment. Perineural, vascular, and extracapsular invasion were associated with N stage. Median DFS and OS were 3.2 and 4.7 years, respectively. Parotid primary site, vascular invasion, extracapsular invasion, and facial nerve sacrifice were associated with worse survival. Adjuvant therapy was not associated with survival. Conclusion: Early T stage SDC is an aggressive malignancy with median DFS of 3.2 years and median OS of 4.7 years. Predictors of survival include primary site, vascular invasion, facial nerve sacrifice, and extracapsular invasion. Despite low T stage and aggressive treatment, prognosis is poor for these patients. Author Disclosure: A. Sharma: None. N.C. Schmitt: None. M.R. Gilbert: None. S. Kim: None.
315 Regionally Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck: Survival and High-Risk Features M. Amoils,1 C.S. Lee,2 J. Sunwoo,2 S.Z. Aasi,2 W. Hara,3 J. Kim,2 D. Sirjani,2 A.D. Colevas,3 A.L.S. Chang,2 and V. Divi3; 1Stanford Otolaryngology, Stanford, CA, 2Stanford, Stanford, CA, 3Stanford University, Stanford, CA Purpose/Objective(s): To describe treatment outcomes and clinicopathologic correlates for patients treated for regionally metastatic cutaneous squamous cell carcinoma of the head and neck (cHNSCC). Materials/Methods: The study design was a retrospective chart review. CPT and ICD-9 codes were used to identify patients treated for regionally metastatic cHNSCC at our institution. Charts were reviewed to ensure appropriate inclusion and extract demographics, clinicopathologic information, and survival outcomes. The effect of various clinicopathologic variables on overall survival was investigated with a Cox analysis. KaplanMeier survival curves were constructed and compared with the log-rank test. Results: Eighty patients were included with a mean age of 73 years (standard deviation 11.5). The majority presented with recurrent disease (66%). The most common high-risk tumor features were perineural invasion (41%) and extracapsular spread (ECS) (31%). Patients were treated
316 Outcomes and Patterns of Failure for Sinonasal Undifferentiated Carcinoma (SNUC): The Mayo Clinic Experience M.E. Gamez,1 D. Lal,2 M.Y. Halyard,1 W.W. Wong,2 C. Vargas,3 K. Curtis,1 S. Ko,4 R.L. Foote,5 and S.H. Patel1; 1Mayo Clinic, Scottsdale, AZ, 2Mayo Clinic, Phoenix, AZ, 3Mayo AZ, Phoenix, AZ, 4Mayo Clinic, Jacksonville, FL, 5Mayo Clinic, Rochester, MN Purpose/Objective(s): Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive disease arising in the nasal cavity and paranasal sinuses with often dismal outcomes and unclear optimal management. This study was performed to determine the outcomes and patterns of failure for SNUC at the Mayo Clinic. Materials/Methods: We identified for the present institutional review boardeapproved analysis a subset of 40 patients (pts) treated at the Mayo Clinic from 1990 to 2014. The median age at presentation was 56.7 years (range, 29-82). Twenty-four pts (60%) were male. The primary site was nasal cavity in 20 pts (50%) and ethmoid sinus in 10 pts (25%). The majority of the pts, 32 (80%), presented with T4 disease. Twenty-four pts (60%) received trimodality therapy in the form of chemotherapy, radiation therapy (RT), and surgery. Most pts (60%) were treated with intensity modulated RT, and 16 pts (40%) received total doses 60 Gy. The most frequent chemotherapy regimen utilized for the trimodality approach was cisplatin and etoposide in 11 pts (27.5%). Results: The median follow-up for surviving pts was 6.9 years (range, 1.117). A total of 16 pts (40%) experienced recurrent disease, 5 local recurrences (12.5%), 1 regional recurrence (2.5%), and 10 (25%) distant metastasis. The 5-year overall survival (OS), recurrence-free survival (RFS), and locoregional control (LRC) were 44%, 39%, and 71%, respectively. With respect to treatment modality, pts treated with multimodality therapy had improved OS, RFS, and LRC compared to pts treated with single modality therapy. Improved OS was noted in patients receiving intensity modulated RT and also in patients receiving 60 Gy. The most common cause of death was distant metastasis. Acute radiation toxicity was radiation dermatitis grade 1-2 (G1-2) (85%), mucositis G1-2 (60%), and fatigue (50%). Long-term toxicity included nasal dryness (30%), xerostomia (10%), retinopathy and optic neuropathy in (5%), and radionecrosis (2.5%). Conclusion: SNUC is an aggressive malignancy that frequently presents at a locally advanced stage with a high tendency to metastasize. The best outcomes in our series were obtained with a multimodality approach. Modern RT techniques and doses 60 Gy were associated with improved OS. Proton therapy may potentially further improve outcomes by allowing dose escalation with better sparing of normal organs. Optimal sequencing of multimodality therapy still needs to be defined. Author Disclosure: M.E. Gamez: None. D. Lal: None. M.Y. Halyard: None. W.W. Wong: None. C. Vargas: None. K. Curtis: None. S. Ko: None. R.L. Foote: None. S.H. Patel: None.