Adenoid Cystic Carcinoma: A Retrospective Clinical Review Atif J. Khan, M.D., 1 Michael P. DiGiovanna, M.D., 2 Douglas A. Ross, M.D., 3 Clarence T. Sasaki, M.D., 3 Darryl Carter, M.D., 4 Yung H. Son, M.D., 1 and Bruce G. Haffty, M.D. 1 * 1 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 2 Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut 3 Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut 4 Department of Pathology, Yale University School of Medicine, New Haven, Connecticut SUMMARY Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were iden- tified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer’s criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recur- rence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion. Also of interest was the association of perineural invasion with margin status, with 15 of 20 patients with positive margins displaying perineural invasion, while only 5 of 17 with negative margins showed nerve invasion (P = 0.02). On immunohistochemistry, 2 cases of the 29 (7%) tumor specimens found displayed HER-2/neu positivity. No correlation be- tween clinical behavior and positive staining could be demonstrated. Our data concur with *Correspondence to: Bruce G. Haffty, M.D., Department of Therapeutic Radiology, Yale University School of Medicine, P.O. Box 208040, New Haven, CT 06520-8040, USA. Phone: (203) 785-2959; Fax: (203) 785-4622; E-mail: bruce.haffty@ yale.edu Received 17 October 2000; Revised 8 February 2001; Accepted 16 February 2001. Published online 4 April 2001 Int. J. Cancer (Radiat. Oncol. Invest): 96, 149–158 (2001) © 2001 Wiley-Liss, Inc. Publication of the International Union Against Cancer