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To define the indications for elective neck treatment, the cases of 474 previously untreated pati... more To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982. Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors (P < 0.0000~). High-grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate-grade or low-grade tumors (P < 0.0000~). In view of the low frequency of occult metas-tases in the entire group, routine elective treatment of the neck is not recommended. High-grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group. Cancer 1992; 69:615-619. The indications for elective treatment of the neck are not well defined for cancers of major salivary gland orign. It would be useful to have criteria to select patients for whom a neck dissection should be incorporated into the surgical management of the primary tumor or, for those in which radiation therapy for the primary tumor bed is indicated, to select for elective neck radiation. In an attempt to address this issue, we reviewed the cases of patients treated at our institution
To define the indications for elective neck treatment, the cases of 474 previously untreated pati... more To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982. Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors (P < 0.0000~). High-grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate-grade or low-grade tumors (P < 0.0000~). In view of the low frequency of occult metas-tases in the entire group, routine elective treatment of the neck is not recommended. High-grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group. Cancer 1992; 69:615-619. The indications for elective treatment of the neck are not well defined for cancers of major salivary gland orign. It would be useful to have criteria to select patients for whom a neck dissection should be incorporated into the surgical management of the primary tumor or, for those in which radiation therapy for the primary tumor bed is indicated, to select for elective neck radiation. In an attempt to address this issue, we reviewed the cases of patients treated at our institution