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J Neurol Surg B Skull Base 2022; 83(01): 099-104
DOI: 10.1055/s-0040-1718769
Original Article

Adenoid Cystic Carcinoma of the Nasopharynx with Skull Base Involvement: Retrospective National Cohort Analysis of Treatment Paradigms, Outcomes, and Provider Density

Shekhar K. Gadkaree
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Anuraag S. Parikh
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Eric Barbarite
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Allen L. Feng
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Justin McCarty
3   Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
4   Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
,
Stacey T. Gray
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Derrick T. Lin
1   Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
2   Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
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Abstract

Objectives This article examines a national cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for incidence, skull base invasion, overall survival, and treatment paradigms.

Design, Setting, and Participants Retrospective national population-based study using Surveillance, Epidemiology, and End Results program data of patients with ACC of the nasopharynx (NACC) and skull base between 2004 and 2016.

Main Outcomes and Measures Primary outcomes included 5-year overall survival and odds of radiation treatment. Statistical analysis was performed using STATA 15.0 (STATACorp). p-Values < 0.05 were considered statistically significant.

Results Of the 2,385 cases of ACC, 70 cases were classified as NACC. Twenty-one percent (15) involved invasion of the skull base or posterior pharyngeal wall, and 42% (30) were either stage 3 or stage 4. The 5-year overall survival for patients with NACC without skull base invasion was 67% which dropped to 40% with invasion into the skull base. Radiation was used as the primary form of therapy for 62% of NACC and 73% of NACC invading into skull base. Odds of receiving radiation therapy and 5-year survival were not affected by socioeconomic status or density of providers.

Conclusion NACC is rare in incidence and was most commonly treated with radiation therapy when advanced in stage. Prognosis was dependent on invasion through posterior pharyngeal wall and skull base. Provider density and socioeconomic status did not affect odds of radiation or overall survival for NACC.

Keywords

nasopharyngeal malignancy - adenoid cystic carcinoma - skull base - radiation therapy - outcomes

General Disclosures

The authors have not received financial assistance related to this manuscript.


Funding/supporting organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.


These results of this study were presented at the North American Skull Base Society Annual Meeting in February 9, 2020 in San Antonio, TX.




Publication History

Received: 13 February 2020

Accepted: 31 August 2020

Article published online:
04 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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