Huber P E, Debus J, Latz D, Zierhut D, Bischof M, Wannenmacher M, Engenhart-Cabillic R
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Radiother Oncol. 2001 May;59(2):161-7. doi: 10.1016/s0167-8140(00)00273-5.
To compare retrospectively radiotherapy with neutrons, photons, and a photon/neutron mixed beam in patients with advanced adenoid cystic carcinoma of the head and neck. Local control, survival, distant failure, and complications were analyzed.
Between 1983 and 1995, 75 patients with inoperable, recurrent, or incompletely resected adenoid cystic carcinoma of the head and neck received radiotherapy that consisted of either fast 14.1 MV DT neutrons (median dose 16 neutron Gy), linac-based photon irradiation (median dose 64 photon Gy), or both (median dose 8 neutron Gy and 32 photon Gy). Follow-up ranged from 1 to 160 months (median 51 months), and the surviving patients had a minimum follow-up of 3 years at the time of analysis.
The actuarial 5-year local control was 75% for neutrons, and 32% for both mixed beam and photons (P = 0.015, log-rank). This advantage for neutrons in local control was not transferred to significant differences in survival (P > 0.1). The survival is dictated by the tumor diseases due to distant metastases occurring in 29 (39%) of the 75 patients. Positive lymph nodes were the only significant factor (P = 0.001) associated with the development of distant metastases although negative lymph nodes did not predict absence of distant metastases, but predicted a delay of occurrence. In multivariate analysis postoperative radiotherapy (P = 0.003) and small tumor size (P = 0.01) were associated with high local control, while primary therapy (P = 0.006) and negative lymph nodes (P = 0.01) were associated with longer survival. While acute toxicity was similar in all three radiotherapy groups, severe late grade 3 and 4 toxicity tended to be more prevalent (P > 0.1) with neutrons (19%) than with mixed beam (10%) and photons (4%).
Fast neutron radiotherapy provides higher local control rates than a mixed beam and photons in advanced, recurrent or not completely resected adenoid cystic carcinoma of the major and minor salivary glands. Neutron radiotherapy can be recommended in patients with bad prognosis with gross residual disease (R2), with unresectable tumors, or inoperable tumors. The type of radiation does not impact survival, which is dominated by the high number of distant metastases.
回顾性比较中子、光子及光子/中子混合束放疗用于治疗晚期头颈部腺样囊性癌患者的疗效。分析局部控制率、生存率、远处转移及并发症情况。
1983年至1995年间，75例无法手术、复发或未完全切除的头颈部腺样囊性癌患者接受了放疗，放疗方式包括快中子（14.1 MV DT，中位剂量16中子Gy）、直线加速器光子照射（中位剂量64光子Gy）或两者联合（中位剂量8中子Gy和32光子Gy）。随访时间为1至160个月（中位时间51个月），分析时存活患者的最短随访时间为3年。
中子放疗组的5年精算局部控制率为75%，混合束和光子放疗组为32%（P = 0.015，对数秩检验）。中子放疗在局部控制方面的优势并未转化为生存率的显著差异（P > 0.1）。75例患者中有29例（39%）因远处转移导致肿瘤相关死亡，决定生存率的主要因素是肿瘤疾病。阳性淋巴结是与远处转移发生相关的唯一显著因素（P = 0.001），尽管阴性淋巴结并不能预测无远处转移，但可预测远处转移的发生延迟。多因素分析显示，术后放疗（P = 0.003）和肿瘤体积小（P = 0.01）与高局部控制率相关，而初始治疗（P = 0.006）和阴性淋巴结（P = 0.01）与更长的生存期相关。虽然三个放疗组的急性毒性相似，但中子放疗组（19%）的严重晚期3级和4级毒性比混合束放疗组（10%）和光子放疗组（4%）更常见（P > 0.1）。
在治疗晚期、复发或未完全切除的大、小涎腺腺样囊性癌时，快中子放疗比混合束和光子放疗具有更高的局部控制率。对于预后不良、有大体残留病灶（R2）、无法切除或不可手术的肿瘤患者，可推荐中子放疗。放疗类型不影响生存率，远处转移数量多是决定生存率的主要因素。
