UF ACC Series (Mendenhall 2004)

Background

Retrospective single-institution series (University of Florida). N=101 head and neck adenoid cystic carcinoma (ACC), curative intent. RT alone vs surgery + adjuvant RT. Endpoints: local control, distant metastases, survival.

Interventions and follow up

Arm A: RT alone (definitive)
Arm B: Surgery + adjuvant RT
Primary endpoint: Local control, distant metastasis-free survival, overall survival
mFollow up: Median 6.6 yr (range 0.4-30.6)

Results

5-yr / 10-yr local control: RT alone 56% / 43%; surgery + RT 94% / 91%; overall 77% / 69%
Multivariate predictors of local control: T stage (P=.0101), treatment group (P=.0008)
Distant metastasis-free survival (5-/10-yr): 80% / 73%
5-yr OS: RT alone 57%; surgery + RT 77%; overall 68%
Multivariate predictors of survival: T stage (P=.0043), clinical nerve invasion (P=.0011)

Adverse events

Grading: Retrospective; toxicities not formally graded
Late effects: High-dose head and neck RT sequelae (xerostomia, trismus, osteoradionecrosis) at low rates

Conclusions

Surgery + adjuvant RT yields excellent local control (94% at 5 yr) and is optimal for ACC. Selected unresectable disease curable with RT alone. T stage and clinical nerve invasion are strongest prognostic factors; distant metastases (27% at 10 yr) remain the dominant failure pattern.

Key Limitations

Single-institution retrospective; non-randomized treatment allocation with selection bias; toxicity not formally graded; non-uniform RT techniques over a long accrual period.

Clinical Context

Foundational ACC series supporting surgery + adjuvant RT as standard, with definitive RT reserved for unresectable disease. Distant failure unaddressed by locoregional therapy; systemic options remain limited.

References