The indications for elective treatment of the neck in cancer of the major salivary glands

TLDR

The study aimed to establish criteria for elective neck treatment in patients with locally confined major salivary gland cancers. A retrospective review of 474 untreated patients treated between 1939 and 1982 was conducted, with clinical data on nodal status and tumor characteristics collected. Occult nodal metastases occurred in 12 % of patients, with size ≥4 cm and high grade independently predicting a 20 % and 49 % risk respectively, leading to the conclusion that routine elective neck treatment is unwarranted except for large or high‑grade tumors.

Abstract

To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982, Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors [P < 0.00001). High-grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate-grade or low-grade tumors [P < 0.00001). In view of the low frequency of occult metastases in the entire group, routine elective treatment of the neck is not recommended. High-grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group.