. Thesis (Ph.D)-Cairo University,2019

Bibliography: p. 134-144.

Objective: Concurrent chemoradiation value of the resected salivary tumor adjuvant context against regular radiation therapy alone. Design: Prospective randomized clinical trial. Patients: 48 patients were randomized to either adjuvant postoperative radiology alone versus concurrent chemoradiotherapy (weekly cisplatin 40 mg/m2 for 6 cycles) “with resected high-risk salivary tu- mors of the large and minor salivary gland”. Main Outcome Measures: Re- current locoregional Free survival, distant free survival, and overall survival. Results: Out of the 48 participants in the study 31 patients had parotid gland tumors. 23 patients received solely adjuvant radiation while 25 patients re- ceived concurrent chemoradiotherapy. In the chemoradiation group, plati- num-based regimens were employed in all. The mean age in both groups was 48 years. Adenoid cystic carcinoma was the primary pathogenic form of both arms 56% (28 cases). Stage II patients were 35% and 32%, stage III was 39% and 48% and stage VIa were 26% and 20% in the radiation arm and chemo- radiotherapy arm respectively. 40 of 48 patients (83%) had close or positive surgical margins and 30 of 48 patients (62%) have a perineural invasion. Both risk variables are more or less well balanced in both arms with no statistical difference. The 2- and 4-year estimates of the locoregional recurrence-free survival rate in the chemoradiation group were 95% and 73%, compared to 77.4% and 43.6% in the radiation arm respectively (p = 007). In the two-and four-year-old chemoradiation arm distant free metastases were 100% and 59% compared to 68% and 39% respectively in the radiation arm (p = 0.08). The overall survival estimates for 2 and 4 years were 93% and 78% respec- tively in the Chemoradiation group but in the radiation-alone group were 95% and 48% respectively. The statistically significant differences were p = 0.009 by log-rank testing. Treatment was generally tolerated, although, in the chemoradiation group adverse symptoms, mainly mucositis increased. Con- clusions: Adding weekly cisplatin as a radiosensitizer for locally advanced stage or high-grade salivary gland cancer with adjuvant conventional radia- tion looks to be helpful and justifies further exploration in selected patients