I found more* "CompHealth found <strong>the</strong> perfect match for me. 1 like thiit kind <strong>of</strong> one-on-one attention—ihey diii an excellent job." Ailm D. Wiliimm. M.D, PENNSYLVANIA —PROGRESSIVE HOSPITAL EXPERIENCING PHENOMENAL GROWTH seeks general ENT. Client is building new state-<strong>of</strong>-<strong>the</strong>-art center for ENT specifically. Be busy immediately with large referral base <strong>of</strong> 40 physicians. Salary is approximately 5300K, plus production bonus that equates to 70% <strong>of</strong> net income. Phenomenal benefits, including relocation. Family-oriented community located in picturesque Amish country. Easy access to Pittsburgh, Cleveland and numerous attractions. For more information on this prestigious position, contact Bruce Guyant today! 800-328-3666, ext. 7911 bgu yan t@co mphealth -com. Ref. #913011 2005 CompHealth lEPRI, 666 Circle 116 on Reader Service Card Reprints <strong>of</strong> articles published in ENT JOURNAL are available (in quantities <strong>of</strong> 100 or more) by contacting; Al Palmisano Bergano Reprint Marketing 866-377-6454 KHAFIF, ANAVI, HAVIV, FIENMESSER, CALDERON, MARSHAK Table 4. Survival and mortality according status among <strong>the</strong> 34 patients With ACC Without ACC Total Alive n(%) 1 {2.9} 10(29.4) 11 (32.3) Died n (%) 19 (55.9) 4(11.8) 23 (67.7) to disease Total n(%) 20 (58.8) 14 (41.2) 34(100) our patients, but we cannot draw any conclusions because <strong>of</strong><strong>the</strong> selection bias—that is. patients with more advanced disease were also treated with radio<strong>the</strong>rapy. In ano<strong>the</strong>r study. Spiro et al' reported that postoperative radio<strong>the</strong>rapy conferred no advantage, but o<strong>the</strong>rs^'' have shown that ACC is radiosensitive, although not necessarily radiocurable." Radiation, <strong>the</strong>refore, might still be <strong>of</strong> value both in treating (postoperutively) locally advanced disease and in treating patients who refuse surgical resection. As expected, both regional recurrence and distant metastasis were predictors <strong>of</strong> poor survival, and aggressive treatment <strong>of</strong> recurrences did not have an effect on outcome. Treatment delivered to <strong>the</strong> neck should be tailored to <strong>the</strong> specific site <strong>of</strong> origin, as has been proposed by Garden et al.'" In our series, <strong>the</strong>re was not even I case <strong>of</strong> regional recun-ence among <strong>the</strong> 12 patients with parotid ACC. as opposed to 11 regional recurrences in <strong>the</strong> remaining 22 patients (50.0%). We suggest careful evaluation and foilowupexaminations <strong>of</strong><strong>the</strong> neck, including ultrasonography. in cases <strong>of</strong> ACC that originate in <strong>the</strong> minor <strong>salivary</strong> glands. Surgery shouldentall lymph node dissection, which can be limited to <strong>the</strong> area <strong>of</strong> maximal drainage; one such option is supraomohyoid neck dissection for oral cavity tumors. Again, we emphasize <strong>the</strong> poor prognosis <strong>of</strong> our patients with regional recurrences (survival: 8.3'7^). indicating <strong>the</strong> importance <strong>of</strong> prevention <strong>of</strong> regional recurrence. In <strong>the</strong> specific case <strong>of</strong> ACC <strong>of</strong> <strong>the</strong> submandibular gland, we recommend surgical excision <strong>of</strong> <strong>the</strong> submandibular triangle as <strong>the</strong> biopsy procedure. We cannot recommend elective treatment to <strong>the</strong> neck for <strong>the</strong>se patients because <strong>of</strong> <strong>the</strong> small number <strong>of</strong> patients in our study who had primary disease at that site. Obviously, more studies are needed to determine <strong>the</strong> patterns <strong>of</strong> regional spread in ACC, as well as <strong>the</strong> preferred treatment modality and <strong>the</strong> role <strong>of</strong> preventive neck dissections. Of <strong>the</strong> 6 patients in our series who received chemo<strong>the</strong>rapy. I had early-stage disease and survived, and <strong>the</strong> o<strong>the</strong>r 5 had advanced disease and died <strong>of</strong> <strong>the</strong>ir disease despite aggressive treatment. Thus, in contrast to findings reported by Spiroet al,^ we observed no advantage to adding chemo<strong>the</strong>rapy to tfie treatment protocol for patients with advanced ACC. Asimilar observation was reported by Hill et al. who found that <strong>the</strong> combination <strong>of</strong> cispiatinum and 5-fluorouracil resulted in no major improvement in survival ENT-Ear, Nose & Throat Journal • October 2005
ADENOID CYSTIC CARCINOMA OF THE SALIVARY GLANDS: A 20 YEAR REVIEW WITH LONG-TERM FOLLOW-UP Table 5. Outcome <strong>of</strong> <strong>the</strong> 27 patients with minor <strong>salivary</strong> gland tumors Disease-free survival* n(
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