Nagliati Michele, Bolner Andrea, Vanoni Valentina, Tomio Luigi, Lay Giancarlo, Murtas Rita, Deidda Maria Assunta, Madeddu Angela, Delmastro Elena, Verna Roberta, Gabriele Pietro, Amichetti Maurizio
Department of Radiation Oncology, Santa Chiara Hospital, L.go Medaglie d'Oro, 38100 Trento, Italy.
Tumori. 2009 Jul-Aug;95(4):442-8. doi: 10.1177/030089160909500406.
Major salivary gland cancers are rare, with many histologic types and subtypes. The low incidence and heterogeneity of primary parotid carcinomas makes their outcome difficult to evaluate. Treatment remains primarily surgical, but optimal therapeutic regimens have yet to be fully realized. The present study reviews the experience of three Italian institutions in the treatment of primary parotid carcinomas in order to describe the clinicopathological presentation and treatment options with emphasis on radiotherapy and to analyze the factors influencing survival.
The records of 110 patients with primary parotid neoplastic lesions treated at three Italian institutions from 1993 to 2004 were retrospectively reviewed. Six patients were excluded from the study: 3 received surgery alone and 3 were not assessable, for a total of 104 assessable patients. Acute and late toxicity of radiotherapy was quantified following the recommendations of the RTOG/EORTC. Survival was analyzed by the actuarial Kaplan-Meier product-limit method. The influence of selected factors on 10-year disease-specific survival was analyzed.
The 104 assessable patients were treated as follows: 11 patients received radiotherapy as their only treatment (3 with a palliative purpose) and 93 had postoperative radiotherapy. Thirty-two patients underwent neck dissection: neck lymph node metastases were found in all them. Their mean age was 60 years (range, 14-92). According to the UICC/2002 TNM Classification, 8 patients were stage I, 19 stage II, 34 stage III, 25 stage IVA, 5 stage IVB, 3 recurrent and 10 not assessable (Tx). The most frequent histologies were adenoid cystic carcinoma (n = 16), mucoepidermoid carcinoma (n = 15), and acinic cell carcinoma (n = 15). Twenty-three patients had recurrences: 10 had local recurrences, 3 neck recurrences, 9 distant metastases, and 1 patient had both local recurrence and distant metastases. No factors were observed that would negatively influence the prognosis. Actuarial 10-year disease-specific survival was 71% and actuarial 10-year local control 82%.
The treatment of salivary gland malignancies remains primarily surgical. Our study confirms the results of the literature with surgery and adjunctive radiotherapy in patients with advanced-stage disease. No variables were observed to influence the prognosis.
大唾液腺癌较为罕见，具有多种组织学类型和亚型。原发性腮腺癌的低发病率和异质性使得其治疗结果难以评估。治疗仍以手术为主，但最佳治疗方案尚未完全明确。本研究回顾了三家意大利机构治疗原发性腮腺癌的经验，以描述临床病理表现和治疗选择，重点是放疗，并分析影响生存的因素。
回顾性分析了1993年至2004年在三家意大利机构接受治疗的110例原发性腮腺肿瘤性病变患者的记录。6例患者被排除在研究之外：3例仅接受了手术治疗，3例无法评估，共计104例可评估患者。按照RTOG/EORTC的建议对放疗的急性和晚期毒性进行量化。采用精算Kaplan-Meier乘积限法分析生存率。分析选定因素对10年疾病特异性生存的影响。
104例可评估患者的治疗情况如下：11例患者仅接受放疗（3例为姑息性放疗），93例接受术后放疗。32例患者接受了颈部清扫术：所有患者均发现颈部淋巴结转移。他们的平均年龄为60岁（范围14 - 92岁）。根据UICC/2002 TNM分类，8例为I期，19例为II期，34例为III期，25例为IVA期，5例为IVB期，3例复发，10例无法评估（Tx）。最常见的组织学类型为腺样囊性癌（n = 16）、黏液表皮样癌（n = 15）和腺泡细胞癌（n = 15）。23例患者出现复发：10例局部复发，3例颈部复发，9例远处转移，1例患者既有局部复发又有远处转移。未观察到对预后有负面影响的因素。精算10年疾病特异性生存率为71%，精算10年局部控制率为82%。
唾液腺恶性肿瘤的治疗仍以手术为主。我们的研究证实了文献中关于晚期疾病患者手术及辅助放疗的结果。未观察到影响预后的变量。
