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Surgical management of lung metastases in adenoid cystic carcinoma of salivary gland Adenoid cystic carcinoma (ACC) of salivary gland is a
very rare disease, comprising approximately 10% of all epithelial salivary
neoplasms. Distant metastases occur in 25-50% of cases, even many
years after the diagnosis. The lung followed by bone, brain and liver are
the common sites. Twenty percent of patients with distant metastases is
still alive at 5-years. The survival is strictly related to the site of
disease metastatization, being lung the metastatic site with a better
outcome compared to bone dissemination. Palliative chemotherapy and radiotherapy are resorted
to symptomatic or progressive disease that can not be otherwise controlled,
without any chance of care. Pulmonary resection is currently the standard treatment
for a variety of tumours, in which the complete removal of all metastatic
lesions is associated with a long term survival. A retrospective review of 20 ACC patients with lung
metastases, referred to our
Institute from 1982 to 2001 and submitted to pulmonary metastasectomy, was
performed. All patients were free of local recurrence at lung metastases
diagnosis. We have observed that radical resection is more related with a
low tumor burden, minor than 6 lesions along with unilateral lung
involvement. A disease free interval > 36 months between the
treatment of the primary tumor and the diagnosis of lung metastases
identifies a subset of patients with a favourable prognosis. Three out of
20 patients are alive without disease at 68+, 20+ and 11+ months after the
metastasectomy, however we do not know if these figures could be
translated into a survival benefit. Since effective systemic treatments
are virtually lacking, lung metastasectomy could be resorted in highly
selected patients. We suggest a periodic follow up be performed with a
chest x-ray every 6 months for the first five years after the primary
surgery, at least once at year after five years, to detect lung lesions as
early as possible in view of metastasectomy. Bibliographical reference:
Laura Locati Medical Oncology Unit / Head and Neck Unit, Istituto Nazionale dei Tumori, Milan, Italy
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