Product information and disease description Place of product in therapy Disease description

Long-term morbidity

6 evidence topics · 6 sources

Summary: long-term morbidity

Long-term morbidity in ACC results from the tumor (perineural spread with facial pain, paralysis, and cranial neuropathies), from repeated local therapy for recurrences, and from the need for lifelong follow-up because distant metastases can occur more than 20 years after diagnosis. In a multinational study of 60 survivors of salivary gland cancer (all histologies) more than 5 years after diagnosis, the most frequently reported long-term problem was dry mouth (21 participants, about one third), and the most frequent grade 2 to 3 clinician-assessed toxicities were hearing impairment (13), soft tissue fibrosis (9), dry mouth (8), and cranial neuropathies (8). No study reporting long-term morbidity specifically for solid or high-grade ACC was identified.

Late toxicities and persistent symptoms in long-term salivary gland cancer survivors

“Altogether, 60 survivors from nine countries participated and reported dry mouth (mean score 37.2), use of painkillers (35.0), problems with sexuality (30.1), insomnia (28.9), fatigue (27.8), trismus (24.9), and sticky saliva (23.3).” (opens the source at this quote in a new tab)
“The most frequent toxicities were hearing impairment, soft tissue fibrosis, dry mouth, and cranial neuropathies.” (opens the source at this quote in a new tab)
“The most frequently named was dry mouth, which was mentioned by a third of all participants (n = 21). The second‐most frequent were pain in the head and neck as well as difficulties swallowing, each mentioned by 10 survivors” (opens the source at this quote in a new tab)

Treatment sequelae: facial nerve paralysis and functional impairment

“Examples of known problems related to salivary gland tumor treatment include facial nerve paralysis” (opens the source at this quote in a new tab)
“hypo‐ and hyperesthesia, pain, dry mouth, dry eyes, swallowing problems, and fear of recurring disease” (opens the source at this quote in a new tab)

“Apart from intraoperative surgical complications that occur during the removal of the tumor, the most common complication seen is the recurrence of the malignancy which is more commonly seen in patients with large, bulky tumors with lymphovascular infiltration and/or positive nodal status.” (opens the source at this quote in a new tab)

Lifelong risk of late recurrence and metastasis

“The latter is especially true for patients with adenoid‐cystic carcinoma; their risk of distant metastasis (primarily to the lungs) is high even after 20 years, so these patients may need life‐long follow‐up, much longer than is usual for head and neck cancer.” (opens the source at this quote in a new tab)

“Additionally, while ACC may have a favorable short term outcome, it is a relentless disease with late recurrences and metastases, necessitating long-term follow-up” (opens the source at this quote in a new tab)

“Overall 10-year, 20-year, and 25-year survivals were 63.7, 27.3, and 20.0%, respectively. Similarly, disease-specific survival (DSSs) was 65.7, 51.2, and 38.4%, respectively, and disease-free survival was 25.2, 9.4, and 9.4%, respectively.” (opens the source at this quote in a new tab)

Duration of follow-up required and late effects of local therapy

“The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15 years.” (opens the source at this quote in a new tab)
“Unfortunately, local recurrences occur despite combined treatment with surgery and radiotherapy. Some authors postulate that postoperative radiation may delay rather than prevents recurrence” (opens the source at this quote in a new tab)
“Furthermore, severe late side effects of this approach include necrosis of the soft tissues, mandible, temporal bone and the temporal brain lobe, as well as cervical myelopathy and sensorineural hearing loss” (opens the source at this quote in a new tab)

Pulmonary metastasis and surveillance requirements after high-grade transformation

“Both HGT and non-HGT showed a high frequency of distant metastasis (78.3% vs. 52.2%), with the lungs being the primary metastatic site. Therefore, postoperative CT of the lungs should be performed as a standard follow-up assessment for patients with ACC, particularly for HGT patients who require close monitoring.” (opens the source at this quote in a new tab)