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THE INFLUENCE OF POSITIVE MARGINS AND NERVE INVASIONIN ADENOID CYSTIC CARCINOMA OF THE HEAD AND NECK TREATEDWITH SURGERY AND RADIATION;INTRODUCTION;I --- predominantly cribriform ACC II --- mixed ACC, consisting of  cribriform/tubular or cribriform/solid III--- predominantly solid ACC.;; arising from salivary glands infiltrate into adjacent tissues without well-defined borders. even with CT/MRI ----- often underestimated more difficult to clear surgically ---- positive margins Former report --- 73% palate ACC have adjacent sites involvement or micro-extension far beyond gross margin;Strong propensity for invading nerves High rate of focal perineural invasion moderate of invading large cranial nevers spread the skull and beyond associate with high local failure rate ;Prognosis;1962-1991 198 patients with head and neck primary tumors treated with surgery and post-RT known or suspected microscopic residual disease. excluded: 48 patients --- with macroscopic disease (with or without surgery) 4 patients --- with distant metastases 2 patients --- part treatment at other institutions 1 patient --- treated to the base of skull only ;Pretreatment evaluation;;Lymph node and surgery;Radiation ;Neck radiation;RESULTS;Local control;Local control – margin status;Local control – nerve involvement;Local control – margin nerve status;LC -- Dose never/margin status;Freedom from relapse;Survival ;Discussion; surgery alone in M.D.Anderson small low grade lesions with clear margins and no perineural invasion parotid gland tumors postoperative RT 93%;surgery;Recommend Dose;RT field ;P.E. Huber et al. / Radiotherapy and Oncology 59 (2001) 161-167;CONCLUSIONS;;3. Patients receiving 50-55 Gy, particularly if they had positive margins, had worse local control, and we recommend a minimum of 60 Gy to