Salivary Carcinosarcoma: An Extremely Rare and Highly Aggressive Malignancy,
Avigeet Gupta BS  Sina Koochakzadeh BS  David M. Neskey MD, MSCR  Shaun A. Nguyen MD, MA  Eric J. Lentsch MD
First published: 10 July 2019 https://doi.org/10.1002/lary.28183
Editor's Note: This Manuscript was accepted for publication on June 24, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract
Objectives/Hypothesis
Carcinosarcomas represent a rare entity of mixed malignant tumors of the salivary gland with limited evidence regarding management strategies. We aim to demonstrate the incidence, prognostic factors, and conduct a survival analysis for this aggressive malignancy.

Study Design
Retrospective database review.

Methods
The Surveillance, Epidemiology, and End Results database was queried for all cases of major salivary carcinosarcoma and its incidence from 1973 to 2015 to identify 66 patients.

Results
The incidence of this tumor was 0.02 cases per 1 million, with a rising number of absolute cases in the past 2 decades. The parotid gland was the most common site (78.8%) of involvement. The 5‐year overall survival was 37% and 5‐year disease‐specific survival was 62%. Surgery was most common management strategy (95.5%), with total parotidectomy and facial nerve sacrifice procedures for those with parotid disease. Radiotherapy was commonly performed (75.8%) and chemotherapy use was rare (18.2%). Patients with distant metastasis had a greater than threefold increase in mortality, and those with total parotidectomy surgery had decreased mortality.

Conclusions
Carcinosarcomas of major salivary glands are extremely rare and highly aggressive tumors. We recommend prompt surgical management and postoperative radiation for this tumor with a poor prognosis.

Level of Evidence
NA

Laryngoscope, 2019