Evaluating safety of observation after resection of low- and intermediate-grade major salivary cancers with isolated perineural invasion with or without facial nerve sacrifice
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: The oncologic benefit of adjuvant radiotherapy (aRT) and the impact of facial nerve sacrifice have not been examined for early-stage low- and intermediate-grade salivary gland carcinomas (LIG-SGCs) with isolated perineural invasion (PNI) and no other adverse features. METHODS: Using a multi-institutional, international cohort established by the American Head and Neck Society (AHNS) Salivary Gland Section, we examined T1-2N0 LIG-SGCs, excluding tumor spillage, positive margins, positive lymphovascular invasion, and unreported PNI. We compared local recurrence rates between the isolated PNI and control arms. Multivariate hazard regression was used to evaluate the risk of local recurrence across PNI, adjuvant radiation therapy (aRT), and facial nerve sacrifice. RESULTS: Among 336 patients across 35 centers, 24 (7 %) patients had isolated PNI as the only high-risk feature. aRT was significantly more common among patients with isolated PNI (n = 10/24 or 42 %, RR: 2.32, 95 % CI: 1.37-3.94) than controls (n = 56/312 or 18 %). aRT was not significantly associated with local control, even after controlling for PNI and facial nerve sacrifice (HR: 0.34, 95 % CI: 0.04-3.06). Within the isolated PNI cohort, one recurrence occurred in the aRT group (n = 1/10, 10 %) and one in the group without aRT (n = 1/14 or 7 %). Thirty (91 %) patients who underwent facial nerve sacrifice had no PNI on final histopathology, with all 30 having full preoperative facial nerve function. CONCLUSIONS: aRT may not necessarily reduce local recurrence for early-stage LIG-SGCs with isolated PNI. In patients with preoperative normal facial nerve function, facial nerve sacrifice may not be necessary.
Authors: Alexandra T. Bourdillon, Peter Callas, Mirabelle Sajisevi, Karolina A. Plonowska-Hirschfeld, Andrew Holcomb, William R. Ryan, Ameya A. Asarkar, Ricardo Aulet, Rebecca K. Bell, Michael A. Blasco, Vanessa B. Bowmaster, Clayton P. Burruss, Jeffson Chung, Kimberly Chan, Brent A. Chang, Charles S. Coffey, David M. Cognetti, Dylan J. Cooper, Joehassin Cordero, John Donovan, Yue (Jennifer) Du, Yusuf Dundar, Rogerio A. Dedivitis, Heather A. Edwards, Boban M. Erovic, Philip A. Feinberg, Emily A. Garvey, Antoine Eskander, David P. Goldstein, Joseph F. Goodman, Rafael N. Goulart, Neerav Goyal, Stefan Grasl, Jonathan P. Giurintano, Nikita Gupta, Andy M. Habib, Trevor G. Hackman, Jared H. Hara, Christina Henson, Michael L. Hinni, Nadia Hua, Stephanie Johnson-Obaseki, Aditya Juloori, Noah S. Kalman, Alexandra E. Kejner, Sobia F. Khaja, Jamie A.M. Ku, Arnaud Lambert, Bao K. Luu, Kelly R. Magliocca, Luiz R. Medina dos Santos, Cara Michael, Brett A. Miles, Giulianno Molina de Melo, Michael G. Moore, Gregoire B. Morand, Kauê Moura, Laith Mukdad, Kenny Nguyen, Rusha Patel, Joseph A. Paydarfar, Nader Sadeghi, Leba M. Sarkis, Fabrice N. Savaria, Nicole C. Schmitt, Justin Shapiro, Timothy B. Shaver, Sandro J. Stoeckli, Maie St. John, William Alvo Stokes, Anita Sulibhavi, Jason Tasoulas, Carrisa M. Thomas, Varun Vendra, Daniel B. Vinh, Celina G. Virgen, Emre Vural, Christian Wooten, Neil M. Woody, Geoffrey D. Young
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,630
OpenAlex ID: W4416898456