Adjuvant radiotherapy for locally advanced (T3–4) major salivary gland cancer – survival benefits quantified
Reviewed by Christopher Burgess

Complete surgical excision of major salivary gland cancers (MSGCs) is the current mainstay of curative treatment for this disease. Indications for postoperative radiotherapy according to current UK national guidelines include high-grade tumours, advanced-stage (stage 3–4) tumours, involved resection margins, perineural and/or lymphovascular invasion, and extra-nodal extension, following revision resection and for adenoid cystic carcinoma. The authors of this paper investigated the utilisation of adjuvant radiotherapy (aRT) for patients with pT3-4N0M0 MSGCs without evidence of other adverse pathological features. The outcomes in terms of overall survival for patients treated with and without aRT were also compared. This was achieved through interrogation of the US National Cancer Database from 2006 to 2018. Of 897 patients who met the inclusion criteria, only 368 (41%) underwent aRT. This was in spite of National Comprehensive Cancer Network (NCCN) guidelines mirroring UK guidelines in terms of recommending aRT for pT3-4N0M0 MSGC. In the majority of patients not undergoing aRT (78.8%), aRT was not part of the planned treatment course, whilst in 13.4%, aRT was recommended but refused by the patient. Contraindication to aRT on account of patient risk factors was recorded as the reason for omission of aRT in only 2.1% of cases. The reasons why aRT was not recommended for 59% of patients, despite being indicated based on tumour pathology, are unclear. The cohort who did not undergo RT were slightly older on average (median 67 vs. 61 years) but this small difference is unlikely to be the sole reason for not offering aRT. Whilst this age difference may contribute to the observation that patients undergoing aRT had a higher five-year overall survival than those not undergoing aRT (82.9% vs. 67.0%, P < 0.001), it is again highly unlikely to be the main factor. Overall, the results from this study support the recommendation to offer aRT to patients with pT3-4N0M0 MSGCs, given its association with significantly higher overall survival. Further work would potentially be helpful to understand why aRT was not part of the planned treatment for patients with this disease in spite of its recommendation in national guidelines.

Adjuvant radiotherapy in pT3-4N0M0 major salivary gland cancer without other adverse features.
Patel AM, Haleem A, Kaki PC, et al.
AM J OTOLARYNGOL
2025;46(5):104628.