Salivary gland tumors in survivors of childhood cancer.

BACKGROUND: There is an increased incidence of second malignant neoplasms in survivors of childhood cancers. The most common second malignancies are acute leukemia, bone and soft tissue tumors, and carcinoma of the skin, breast, and thyroid. Although, ionizing radiation has been demonstrated to increase the risk of developing a salivary gland neoplasm, there are few reports of salivary gland neoplasms occurring in patients treated for cancer in childhood.
METHODS: A retrospective review of the patient registry of St. Jude Children's Research Hospital from 1963-2003.
RESULTS: Twelve survivors of childhood cancer developed a salivary gland neoplasm after completion of treatment. These patients were initially treated for a variety of childhood cancers with a combination of radiation and chemotherapy. The pathology of the salivary gland tumors were mucoepidermoid carcinoma (10), adenoid cystic carcinoma (1) , and pleomorphic adenoma (1). All patients were treated with surgical excision of the primary tumor, and postoperative radiation was added in select patients. Eleven patients were alive with no evidence of disease at last follow-up, and 1 patient was alive with clinical evidence of pulmonary metastasis.
CONCLUSION: Radiation and chemotherapy used to treat patients with childhood malignancies increases the risk of developing a second neoplasm of salivary gland origin. The majority of these neoplasms are malignant; mucoepidermoid carcinoma occurs most frequently. The treatment of these tumors includes surgical excision of the primary, with neck dissection in patients with clinical evidence of nodal metastasis, and postoperative radiation added for pathologies with adverse features. EBM RATING: C-4.