Clinical pathological features and radiotherapy treatment for adenoid cystic carcinoma of the head and neck

Adenoid Cystic Carcinoma (ACC) is a slow-growing, locally invasive malignant tumour, with a deceptively benign histological appearance, a high probability of local recurrence and distant metastasis. The tumour comprises basaloid cells with small, angular and hyperchromatic nuclei and scarce cytoplasm arranged into three significant prognostic patterns: cribriform, tubular, and solid. In some tumours, dedifferentiation to a high-grade form occurs. The authors have reviewed numerous studies which have attempted to demonstrate accurate histological prognostic features, but these have often produced conflicting results. The literature review suggests that Analysis of microarray and gene expression profiles provided new potential diagnostic and prognostic markers. However, tumor grade, lymph node metastasis, invasion of major nerves, and resection margin status continue to be the most consistent predictors of prognosis. The optimal treatment of ACC has not yet been fully established, although most studies advocate using surgical excision and postoperative radiotherapy. Careful tumor staging and grading with documentation of perineural invasion and margin status remain important prognostic tools. ACC has been incurable, and most patients will eventually succumb to local recurrence, distant metastasis, or both. The clinical course of the disease can be surprisingly heterogeneous, with some patients surviving decades and others surviving only months. The combination of surgery and radiotherapy in the postoperative period has shown the best locoregional disease control. Contribution to Evidence-Based healthcare: This review contributes to a better understanding of the treatment of patients diagnosed with cystic adenocarcinoma of the head and neck, with regard to treatment with curative radiotherapy, as part of the proposed treatment or even to reduce the effects of the disease.