Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, MA 02114, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):308-14. doi: 10.1016/j.ijrobp.2010.09.042. Epub 2010 Nov 13.
To analyze the recent single-institution experience of patients with salivary gland tumors who had undergone adjuvant intensity-modulated radiotherapy (IMRT), with or without concurrent chemotherapy.
We performed a retrospective analysis of 35 salivary gland carcinoma patients treated primarily at the Dana-Farber Cancer Institute between 2005 and 2010 with surgery and adjuvant IMRT. The primary endpoints were local control, progression-free survival, and overall survival. The secondary endpoints were acute and chronic toxicity. The median follow-up was 2.3 years (interquartile range, 1.2-2.8) among the surviving patients.
The histologic types included adenoid cystic carcinoma in 15 (43%), mucoepidermoid carcinoma in 6 (17%), adenocarcinoma in 3 (9%), acinic cell carcinoma in 3 (9%), and other in 8 (23%). The primary sites were the parotid gland in 17 (49%), submandibular glands in 6 (17%), tongue in 4 (11%), palate in 4 (11%), and other in 4 (11%). The median radiation dose was 66 Gy, and 22 patients (63%) received CRT. The most common chemotherapy regimen was carboplatin and paclitaxel (n = 14, 64%). A trend was seen for patients undergoing CRT to have more adverse prognostic factors, including Stage T3-T4 disease (CRT, n = 12, 55% vs. n = 4, 31%, p = .29), nodal positivity (CRT, n = 8, 36% vs. n = 1, 8%, p = .10), and positive margins (n = 13, 59% vs. n = 5, 38%, p = .30). One patient who had undergone CRT developed an in-field recurrence, resulting in an overall actuarial 3-year local control rate of 92%. Five patients (14%) developed distant metastases (1 who had undergone IMRT only and 4 who had undergone CRT). Acute Grade 3 mucositis, esophagitis, and dermatitis occurred in 8%, 8%, and 8% (1 each) of IMRT patients and in 18%, 5%, and 14% (4, 1, and 3 patients) of the CRT group, respectively. No acute Grade 4 toxicity occurred. The most common late toxicity was Grade 1 xerostomia (n = 8, 23%).
Treatment of salivary gland malignancies with postoperative IMRT was well tolerated with a high rate of local control. Chemoradiotherapy resulted in excellent local control in a subgroup of patients with adverse prognostic factors and might be warranted in select patients.
分析在达纳-法伯癌症研究所接受术后调强放疗（IMRT）辅助治疗的唾液腺癌患者的近期单机构经验，包括接受或未接受同期化疗的患者。
我们对 2005 年至 2010 年间在达纳-法伯癌症研究所接受手术和辅助 IMRT 治疗的 35 例唾液腺癌患者进行了回顾性分析。主要终点是局部控制、无进展生存期和总生存期。次要终点是急性和慢性毒性。在幸存患者中，中位随访时间为 2.3 年（四分位间距，1.2-2.8）。
组织学类型包括腺样囊性癌 15 例（43%）、黏液表皮样癌 6 例（17%）、腺癌 3 例（9%）、腺泡细胞癌 3 例（9%）和其他 8 例（23%）。原发部位为腮腺 17 例（49%）、颌下腺 6 例（17%）、舌 4 例（11%）、腭 4 例（11%）和其他 4 例（11%）。中位放疗剂量为 66Gy，22 例（63%）患者接受 CRT。最常见的化疗方案为卡铂联合紫杉醇（n=14，64%）。接受 CRT 的患者具有更多不良预后因素的趋势，包括 T3-T4 期疾病（CRT，n=12，55% vs. n=4，31%，p=0.29）、淋巴结阳性（CRT，n=8，36% vs. n=1，8%，p=0.10）和切缘阳性（n=13，59% vs. n=5，38%，p=0.30）。1 例接受 CRT 的患者发生了野内复发，导致总 3 年局部控制率为 92%。5 例（14%）患者发生远处转移（1 例仅接受 IMRT，4 例接受 CRT）。IMRT 患者中出现急性 3 级黏膜炎、食管炎和皮炎的比例分别为 8%、8%和 8%（各 1 例），CRT 组分别为 18%、5%和 14%（4、1 和 3 例）。未发生急性 4 级毒性。最常见的晚期毒性是 1 级口干（n=8，23%）。
术后 IMRT 辅助治疗唾液腺癌的耐受性良好，局部控制率高。在具有不良预后因素的患者亚组中，放化疗联合治疗可获得极好的局部控制，可能对某些患者有效。
