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ORIGINAL ARTICLE

Salivary Gland Carcinoma of the Larynx
Mao-Che Wang1,3, Chia-Yu Liu1,3, Wing-Yin Li2,3, Shyue-Yih Chang1,3, Pen-Yuan Chu1,3* Departments of 1Otolaryngology and 2Pathology, Taipei Veterans General Hospital, and 3 National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Background: Salivary gland carcinomas of the larynx are rare, and account for <1% of laryngeal malignancy. The purpose of this study is to review our management experience of salivary gland carcinomas of the larynx in Taipei Veterans General Hospital and to compare it with other major existing series. Methods: From 1981 to 2000, 11 patients with laryngeal salivary gland carcinomas treated in Taipei Veterans General Hospital were included in this study. Their demographic data, treatment modalities, survival, and failure pattern, obtained by review of medical records, were analyzed. Results: All 11 patients were male. Median follow-up period was 95 months (range, 18–181 months). The 5-year overall survival rate of all patients was 71%, and the 5-year disease-specific survival rate was 83%. Conclusion: The mainstay treatment of laryngeal salivary gland carcinomas in these cases was surgery or surgery with postoperative radiotherapy. The survival rate was satisfactory and similar to that of squamous cell carcinoma of the larynx. [J Chin Med Assoc 2006;69(7):322–325] Key Words: carcinoma, larynx, salivary gland carcinoma

Introduction
Squamous cell carcinoma accounts for about 99% of laryngeal malignancies. Non-epidermoid malignancies of the larynx include sarcoma, lymphoma, and salivary gland carcinoma. Salivary gland carcinomas of the larynx are rare tumors, which account for <1% of laryngeal malignancy.1 Few major series report on a detailed MEDLINE search. The purpose of this study is to review our experiences in diagnosis and therapy of patients with salivary gland carcinoma in Taipei Veterans General Hospital and to compare our treatment results with those of other major existing series.

Methods
From 1981 to 2000, 1,564 patients with laryngeal malignancy treated in Taipei Veterans General Hospital were found from the computer database of the Cancer Treatment Center. Twelve patients from among them were diagnosed with salivary gland carcinoma of the

larynx. One of the 12 patients was excluded from our study due to distant metastasis at the time of diagnosis. The remaining 11 patients were included in this study. Demographic data, clinical staging of tumors, pathologic classifications, treatment modalities, failure patterns, and survival were obtained by reviewing the medical records. Tumors were staged according to the 2002 American Joint Committee on Cancer (AJCC) staging system for laryngeal tumors. All the pathologic slides were re-examined by a single pathologist for histologic study. Clinical and pathologic data were entered into a computer database (Microsoft Access 2000) and statistical analysis of data was performed by using a commercially available computer software package (JMP 4.0, SAS Institute Inc., Cary, NC, USA). The follow-up interval was calculated in months from the date of initial surgery or radiotherapy (RT) to the date of the last follow-up or death, and disease-free interval was calculated from the date of initial surgery or RT to the date of the first recurrence. For disease-specific survival, patients who died of causes unrelated to laryngeal cancer were censored.

*Correspondence to: Dr Pen-Yuan Chu, Department of Otolaryngology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C. E-mail: pychu@vghtpe.gov.tw Received: October 13, 2005 Accepted: March 21, 2006
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© 2006 Elsevier. All rights reserved.

Results All the 11 patients were male. AdenosquaCa = adenosquamous carcinoma. The treatment modalities included surgery. and 57% in 10 years. The median follow-up period was 95 months (range. A total of 9 patients (82%) underwent surgery. The overall survival rate was 71% in 5 years. Stage I and II. J Chin Med Assoc • July 2006 • Vol 69 • No 7 323 . For surgical margins.4%). including 1 supraglottic partial laryngectomy and 1 vertical partial laryngectomy. AdenoCa = adenocarcinoma. TL = total laryngectomy. DNED = died with no evidence of disease. Three patients were at an early stage. histology. Two patients received RT alone as their mainstay treatment. The demographic data. No patient had second primary tumor during the follow-up period. subsites of primary tumor. Seven patients underwent total laryngectomy.Salivary gland carcinoma of the larynx Overall survival rates and disease-specific survival rates were calculated using the Kaplan–Meier product-limit method. laryngeal preservation rate was 36% (4/11) under surgery or RT. and outcome Case 1 2 3 4 5 6 7 Age 48 60 65 63 69 74 61 Sex M M M M M M M Primary site Glottic Glottic Subglottic Glottic Supraglottic Glottic Glottic Stage T3N0M0 T3N0M0 T4N0M0 T3N2bM0 T2N0M0 T4N0M0 T1N0M0 Histology ACC ACC AdenoCa AdenoCa ACC AdenoCa Mucoepi Treatment S RT RT S S S + RT S + RT Type of surgery TL Laryngeal preservation No Yes Yes No Yes No Yes Outcome DNED at 239 mo DNED at 120 mo ANED at 123 mo ANED at 91 mo ANED at 94 mo DNED at 31 mo Local recurrence at 8 mo.2 Adenoid cystic carcinoma was the leading pathologic diagnosis (35. VPL = vertical partial laryngectomy. Tumors of minor salivary gland origin arise from subepithelial glands. 18–181 months).1 It was about 0. Therefore. Only 1 case was high grade and 2 cases were low grade. and 63% in 10 years.76% in our series. Epidemiologic characteristics of patients. details of treatment. Only 2 patients had conservation surgery. ANED = alive with no evidence of disease. All the pathologic slides were re-examined by a single pathologist. Mucoepi = mucoepidermoid carcinoma. Perineural invasion was noted in 2 patients and both of them were adenoid cystic carcinoma. C/T = chemotherapy. In the database of our cancer center. Spiro et al reviewed 492 cases of tumors of minor salivary gland origin in the head and neck in Memorial Hospital during a 25-year period. Four patients were classified as having adenoid cystic carcinoma (Table 1). Neck dissections were performed in 4 patients (2 unilateral and 2 bilateral). RT = radiotherapy. One patient developed local recurrence and 1 developed distant metastasis to the lung. 2 were positive and the remaining were negative. ND = neck dissection. surgery with postoperative RT or RT alone (Table 1). aged from 48 to 84 years with a median of 65.8%). and the most common origin of minor salivary gland tumor was the palate (36. salivary gland carcinomas of the larynx accounted for Table 1. intermediate grade predominated. and TNM staging system are shown in Table 1. Disease-specific survival was 83% in 5 years. Discussion Salivary gland carcinomas of the larynx are rare and account for <1% of laryngeal malignancies. Three patients were classified with mucoepidermoid carcinoma and 3 patients with adenocarcinoma (Table 1). SGL = supraglottic laryngectomy. S = surgery. For cell differentiation. Others were at the advanced Stage III or IV. Surgery alone was performed in 5 patients and surgery combined with postoperative RT was used in 4 patients. Only 3% of salivary gland tumors were in the larynx. ANED at 48 mo ANED at 9 mo ANED at 122 mo Died of lung metastasis at 22 mo TL + ND SGL TL + ND VPL 8 9 10 79 73 58 M M M Glottic + subglottic Supraglottic Glottic + subglottic Glottic + subglottic T2N0M0 T3N2cM0 T4N0M0 Mucoepi Mucoepi ACC S + RT S S + RT + C/T due to lung metastasis S TL TL + ND TL + ND No No No 11 84 M T3N0M0 AdenosquaCa TL No ACC = adenoid cystic carcinoma.

SubG (25) SG (27). S + RT (70) S (55).76) Subsites of tumor (%) SG (37).78) 12/1. 1967 Memorial hospital. Surgery with or without postoperative RT6. the role of RT is unclear. These survival rates are similar. high-grade tumor cell type. RT (33) S (61). The symptoms and signs of laryngeal salivary gland carcinoma are related to location and size. and the site of distant metastasis was also the lung. 1974 MD Anderson.500 (0. They account for <1% of laryngeal Table 2. Hoarseness or even dyspnea is indicative of glottic involvement.M. SubG (22) SG (42). Stridor and airway obstruction might imply a subglottic tumor. and high-grade mucoepidermoid carcinoma.4 In these 37 cases. laryngeal salivary gland carcinomas are rare.10.11 is the widely accepted major treatment modality of laryngeal salivary gland carcinomas. or perineural invasion still tend to be indicative of poor prognosis. ranging from 0. 1985 UCLA. either in conjunction with surgery to prevent distant metastases or with RT as palliation for patients with distant metastases at initial presentation. TG = transglottis. The most frequent site of distant metastasis was the lung. The fact that all the cases in our series were male may partly be due to the fact that veterans were the major patient population in our hospital. male gender and old age were predominant. HY = hypopharynx. TG (27) TNM stage I + II: 1 III + IV: 7 NA NA I + II: 6 III + IV: 12 I + II: 2 III + IV: 10 I + II: 2 III + IV: 9 Treatment (%) S (75). We reviewed 5 major series of a similar topic in the literature3–7 and compared them with our data (Table 2). and are difficult to detect earlier.6) 12/1.87) 18/2.7. (%) 8/NA 17/2. high-grade tumors. This explains why most patients were diagnosed late at the advanced stage in all series. When compared with the treatment results of squamous cell carcinoma of the larynx in our institute between 1981 and 1991. Elective neck dissection is not recommended for those who present with adenoid cystic carcinoma and low-grade mucoepidermoid carcinoma.11 Surgery remains the mainstay treatment for salivary gland carcinoma of the larynx.8 possibly because the distribution density of subepithelial glands is higher in the supraglottic and subglottic areas than in the glottic area. In conclusion. RT (25) S (82). There were many more male than female patients in most series except 1 (UCLA series) where males and females were equal in number. RT (11).2% OS: 71% DSS: 83% *Number of patients with salivary gland carcinoma of the larynx over number of patients with laryngeal malignancy. G (37). TG (50) NA SG (19). 1999 VGH. SG = supraglottis.10 The 5-year overall survival in our series was 71%. DSS = disease-specific survival.564 (0. G = glottis. G (7). Most tumors had supraglottic or subglottic involvement. SubG (13).6 to 0. Chemotherapy may be useful as an adjuvant therapy of high-grade lesions.12 we found the 5-year survival rate to be 67% in squamous cell carcinoma of the larynx and 71% in this study. Although aggressive treatment is recommended.3.68) 27/3.9 Patients will suffer from dysphagia if the tumor is located in the supraglottic area. Wang. et al 1. 63% of patients had supraglottic or subglottic involvement. RT (0). RT = radiotherapy. Data from different centers Institute Barne’s hospital.8% OS: 45. 1968 Mayo Clinic. In our series.2.9 begin as submucosal lesions. AWD = alive with disease. positive surgical margin. adenocarcinoma.547 (0.C. S = surgery. SubG (37). G (33).7. 324 J Chin Med Assoc • July 2006 • Vol 69 • No 7 . Salivary gland carcinomas of the larynx account for a similar percentage of all laryngeal malignancies. SubG = subglottis. but it may be valuable as an adjuvant modality for adenoid cystic carcinoma with perineural spread.100 (0. RT (18). S + RT (28) S (30).10. Ipsilateral neck dissection should be performed in cases with cervical adenopathy.967 (0. The definite diagnosis of laryngeal salivary gland carcinoma is made by biopsy of the laryngeal tumor under laryngoscope and histopathologic examination of the specimen. S + RT (27) Survival (5 yr) 3 ANED/8 2 ANED/17 2 AWD/17 Average survival 69 mo DSS: 42. NA = not available. Toomey3 reported 8 cases of adenocarcinoma of the larynx and reviewed 29 reported cases in the literature. Tumors arising from subepithelial glands1. or positive surgical margin. 2003 *Patient no.87% in these major series.4% (12/856) of all head and neck salivary gland carcinomas. SubG (9). HY (4) SG (78). RT (18) S (67). Ninety-five percent of them had supraglottic or subglottic involvement. Although we did not find any statistically significant factors of better prognosis due to the small sample size. and the 5-year disease-specific survival was 83%. ANED = alive with no evidence of disease. OS = overall survival.6.

Tubbs R. Strong EW. Devine KD. Weiland LH. Glandular carcinoma of the larynx: the UCLA experience. Luna-Ortiz K. Frazell EL. Medina JE. 77:931–61. and only 1–3% of head and neck salivary gland carcinomas. 150:513–8.83: 487–90. Vito AD. Cancer of the minor salivary glands of the larynx.108:485–9. 7. J Otolaryngol Society ROC 1994. A clinicopathologic study of 492 cases.167:116–20. Levine HL. Ann Surg 1968. Cancer 1977. Chang SY. Batsakis JG. Koss LG. Rippey JH.30:215–29. Adenocarcinoma of the larynx. 11. Chang P. Ann Otol Rhinol Laryngol 1999. 9. 8. 10. They usually originate in the supraglottic or subglottic area with a predominance of male gender and old age. Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature. 2. J Laryngol Otol 2001. Spiro RH. 12. Toomey JM. Nonsquamous neoplasms of the larynx. Laryngoscope 1967. Otolaryngol Clin North Am 1997. Supracricoid partial laryngectomy for non-squamous cell carcinoma of the larynx. Cohen J. Hajdu SI.Salivary gland carcinoma of the larynx malignancies. Ann Otol Rhinol Laryngol 1992. 5.40:1307–13. Tumors of minor salivary origin.19:475–88. Neel HB III. Blackwell KE. Surgery alone or in combination with postoperative RT is the main treatment modality. Calcaterra TC. Most patients were diagnosed late at an advanced stage. Luna MA. Veivers D. Brasnu D. Guillamondegiu OM. The overall 5-year survival rate of laryngeal salivary gland carcinoma is similar to that of laryngeal squamous cell carcinoma in our institution. Nonsquamous carcinomas of the larynx. Olofsson J. Wicker JH. References 1. 4. 3. J Chin Med Assoc • July 2006 • Vol 69 • No 7 325 .31:117–29. Namazie A.101: 1024–6.29:376–83. Non-epidermoid cancer of the larynx. Otolaryngol Clin North Am 1986. Laccourreye O. Adenocarcinoma of the larynx. Chu PY. Treatment of laryngeal cancer: analysis of ten years’ cases in VGH. Ann Otol Rhinol Laryngol 1974. El-Naggar AK. Browne JD. Cancer 1973.115:388–92. Van Norstrand AWP. Alavi S. Am J Surg 1985. Taipei. Management of the nonepidermoid cancer of the larynx. Batasakis JG. 6. Cady B.