Pötter R, Naszály A, Hemprich A, Haverkamp U, Al-Dandashi C, Höver K H, Loncar I
Klinik für Strahlentherapie-Radioonkologie-der Westfälischen Wilhelms-Universität Münster, FRG.
Strahlenther Onkol. 1990 Jan;166(1):78-85.
In adenoidcystic carcinoma macroscopic residual disease after surgery, inoperable and recurrent tumors are characterized by relapse rates up to 70% if treated according to conventional treatment strategies including photon radiotherapy. By neutron therapy a tumor control rate of 70% has been reported. At the d,T-generator (14 MeV) in Münster nine patients with adenoidcystic carcinoma of the salivary glands in locally advanced stage have been treated since 1/86. A combined modality schedule (30 Gy photon/5 to 10 Gy neutrons) used in the beginning has been replaced by a definitive neutron therapy (15 Gy) with single fractions of 1.0 to 1.3 Gy in five to six weeks. Treatment planning included CT/MRI as well as computer assisted dose calculations based on a specific software for neutron therapy. The volume reduction by neutron radiotherapy was 82% for advanced disease. Continuous remission was achieved in seven of nine patients in a short follow-up period of medium 15 months (from six to 28 months). The two recurrences occurred at the field edge. Based on this preliminary experience and on a survey of the literature the main issues for neutron therapy in salivary glands tumors in particular adenoidcystic carcinomas are discussed: histology, stage, tumor size, location, surgery, treatment planning and delivery, dose, and side effects. A long term evaluation of neutron therapy within a controlled clinical multicenter trial is proposed.
在腺样囊性癌手术后存在肉眼可见的残留病灶、无法手术切除及复发的肿瘤，如果按照包括光子放疗在内的传统治疗策略进行治疗，其复发率高达70%。据报道，采用中子治疗的肿瘤控制率为70%。自1986年1月以来，在明斯特的d，T发生器（14 MeV）已治疗了9例局部晚期涎腺腺样囊性癌患者。最初采用的联合治疗方案（30 Gy光子/5至10 Gy中子）已被确定的中子治疗（15 Gy）所取代，在五至六周内分单次剂量1.0至1.3 Gy给予。治疗计划包括CT/MRI以及基于特定中子治疗软件的计算机辅助剂量计算。对于晚期疾病，中子放疗后的体积缩小率为82%。在平均15个月（6至28个月）的短期随访期内，9例患者中有7例实现了持续缓解。两次复发发生在射野边缘。基于这一初步经验以及对文献的调研，讨论了中子治疗涎腺肿瘤尤其是腺样囊性癌的主要问题：组织学、分期、肿瘤大小、位置、手术、治疗计划与实施、剂量以及副作用。建议在一项对照临床多中心试验中对中子治疗进行长期评估。
