Objective Salivary duct carcinoma (SDC) is a rare and aggressive malignancy for which an optimal treatment algorithm is lacking. We endeavored to assess the current treatment outcomes for SDC with a multimodality treatment approach combining surgery with adjuvant radiotherapy concurrent chemotherapy.Study Design Case series with chart review.Setting A National Cancer Institute-designated comprehensive cancer center.Subjects and Methods The clinical record of 17 patients with salivary duct carcinoma were analyzed to assess locoregional control, recurrence-free survival, and overall survival.Results All SDC cases (n = 17) were managed with surgical resection, followed by adjuvant radiotherapy (47.1%) or concurrent chemotherapy and radiotherapy (52.9%). Median patient follow up was 37 months. An aggressive disease course was generally observed, with 3-year recurrence-free survival and overall survival of 34.4% and 35.5%, respectively. The majority of recurrences were distant. Intensification with adjuvant concurrent chemotherapy was not associated with improved outcomes on univariate survival analysis.Conclusion For salivary duct carcinoma, a multimodality treatment approach is associated with acceptable locoregional control rates but poor distant control and overall survival. Novel systemic therapies may be needed to optimize clinical outcomes.

Objectives:(1) Analyze the treatment approach for these rare salivary gland neoplasms at our institution. (2) Demonstrate observed patterns of failure and survival for high‐grade salivary duct carcinoma (HGSDC) involving the parotid glands.Methods:Clinical data on 17 patients with nonmetastatic HGSDC involving parotid salivary glands from 1998 to 2012 were abstracted from our institutional database. Inclusion required surgical resection with postoperative radiotherapy (n = 8) or concurrent chemoradiotherapy (n = 9). Demographics, histopathologic features, treatment course, and clinical outcomes were recorded. Specimens were re‐reviewed by a dedicated head and neck pathologist. Overall survival (OS) and disease‐free survival (DFS) were estimated via Kaplan‐Meier method, and comparisons were made with the log‐rank test.Results:Median patient age was 65 years (range, 52‐83 years) with a male:female ratio of 7.5:1 and median follow‐up of 37 months. Most commonly, these cases presented as pT4a (n = 14) with adverse clinical features, including perineural invasion (76.5%), positive lymph nodes (76.5%), and vascular invasion (58.8%). Three‐year DFS and OS were 35.7% and 61.4%, respectively. The pattern of treatment failure was predominately distant (n = 11) versus locoregional (n = 3). Univariate analysis of demographic, histopathologic, and treatment characteristics did not reveal a significant association with OS or DFS. Median survival after metastasis was 13 months, with only a single patient having a sustained treatment response >2 years after disease dissemination.Conclusions:In this series, we highlight the aggressive nature of high‐grade salivary duct carcinoma, which has a significant risk of distant recurrence and poor overall survival.