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Scott M. Kaszuba, MD; Mark E. Zafereo, MD; David I. Rosenthal, MD; Adel K. El-Naggar, MD, PhD; Randal S. Weber, MD

Arch Otolaryngol Head Neck Surg. 2007;133(6):546-550.

Objective  To elucidate the effect on outcome of initial surgical enucleation with or without definitive surgical resection and radiation therapy for patients with submandibular gland carcinoma.

Design  Retrospective clinicopathological review.

Setting  Tertiary referral center.

Patients  Eighty-seven consecutive patients (mean follow-up, 8.7 years) with primary submandibular gland carcinoma.

Main Outcome Measures  Review of proven cases of primary carcinomas of the submandibular gland treated at our institution during a 33-year period to determine the effect of the type of biopsy and subsequent treatment on locoregional disease control, disease-specific survival, and overall survival.

Results  There was no statistically significant difference in locoregional disease control, disease-specific survival, or overall survival between patients undergoing enucleation of the gland vs patients undergoing enucleation of the gland followed by definitive surgical resection before any radiation therapy. There were no locoregional recurrences among 28 patients treated with enucleation and radiation therapy, compared with 3 locoregional recurrences (7%) among 42 patients treated with enucleation followed by definitive surgical resection before any radiation therapy. Twenty-nine (69%) of 42 patients undergoing a second surgical procedure had evidence of residual carcinoma in the final surgical specimen.

Conclusions  En bloc surgical resection followed by radiation therapy remains the standard treatment for patients with submandibular gland carcinoma. Patients without clinical and radiographic evidence of disease after enucleation may be adequately treated with subsequent radiation therapy. Definitive surgical resection remains the treatment of choice for patients with clinical or radiographic evidence of disease after enucleation of the gland.

Author Affiliations: Departments of Head and Neck Surgery (Drs Kaszuba, Zafereo, and Weber), Radiation Oncology (Dr Rosenthal), and Pathology (Dr El-Naggar), The University of Texas M. D. Anderson Cancer Center, Houston.