复发性腺样囊性癌的再放疗：52 例接受光栅扫描碳离子放疗患者的结果分析与评价。
Re-irradiation of adenoid cystic carcinoma: analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy.
机构信息
Dept of Radiation Oncology, University of Heidelberg, Germany.
Dept of Medical Physics, Heidelberg Ion Beam Therapy Center, Germany.
出版信息
Radiother Oncol. 2015 Feb;114(2):182-8. doi: 10.1016/j.radonc.2015.01.002. Epub 2015 Jan 29.
BACKGROUND
Treatment of local relapse in adenoid cystic carcinoma (ACC) following prior radiation remains a challenge: without the possibility of surgical salvage patients face the choice between palliative chemotherapy and re-irradiation. Chemotherapy yields response rates around 30% and application of tumouricidal doses is difficult due to proximity of critical structures. Carbon ion therapy (C12) is a promising method to minimize side-effects and maximize re-treatment dose in this indication. We describe our initial results for re-irradiation in heavily pre-treated ACC patients.
METHODS
Patients treated with carbon ion therapy between 04/2010 and 05/2013 (N=52pts, median age: 54 a) were retrospectively evaluated regarding toxicity (NCI CTC v.4), tumour response (RECIST) and control rates. 48pts (92.3%) received carbon ions only, 4pts received IMRT plus C12.
RESULTS
4pts were treated following R1-resection, 43pts for inoperable local relapse. Most common tumour sites were paranasal sinus (36.5%), parotid (19.2%), and base of skull (17.3%). Pts received a median dose of 51GyE C12/63Gy BED and cumulative dose of 128Gy BED [67-182Gy] after a median RT-interval of 61months. Median target volume was 93ml [9-618ml]. No higher-grade (>°II) acute reactions were observed, 7pts showed blood-brain-barrier changes (°I/II: 8pts; °III: 2pts), 1 pt corneal ulceration, xerophthalmia 7pts, °IV bleeding 1 pt, tissue necrosis 2pts, otherwise no significant late reactions. Objective response rate (CR/PR) was 56.6%. With a median follow-up of 14months [1-39months] local control and distant control at 1a are 70.3% and 72.6% respectively. Of the 18pts with local relapse, 13pts have recurred in-field, 1 pt at the field edge, 3pts out of field, and one in the dose gradient.
CONCLUSION
Despite high applied doses, C12 re-irradiation shows moderate side-effects, response rates even in these heavily pre-treated patients are encouraging and present a good alternative to palliative chemotherapy. Though most local recurrences occur within the high-dose area, further dose escalation should be viewed with caution.
背景
在接受过放射治疗的腺样囊性癌（ACC）局部复发患者的治疗仍然是一个挑战：如果没有手术挽救的可能性，患者将面临姑息性化疗和再放疗的选择。化疗的缓解率约为 30%，由于临近关键结构，应用肿瘤杀伤剂量较为困难。碳离子治疗（C12）是一种有前途的方法，可以最大限度地减少副作用并增加该适应证的再治疗剂量。我们描述了我们在接受过大量预处理的 ACC 患者中进行再放疗的初步结果。
方法
回顾性评估了 2010 年 4 月至 2013 年 5 月期间接受碳离子治疗的 52 例患者（中位年龄：54 岁）的毒性（NCI CTC v.4）、肿瘤反应（RECIST）和控制率。48 例（92.3%）仅接受碳离子治疗，4 例接受 IMRT 加 C12 治疗。
结果
4 例患者在 R1 切除后接受治疗，43 例患者因局部不可切除性复发。最常见的肿瘤部位是鼻窦（36.5%）、腮腺（19.2%）和颅底（17.3%）。患者接受的中位 C12 剂量为 51GyE/63Gy BED，累积剂量为 128Gy BED[67-182Gy]，中位放疗间隔为 61 个月。中位靶体积为 93ml[9-618ml]。未观察到更高等级（>°II）的急性反应，7 例患者出现血脑屏障改变（°I/II：8 例；°III：2 例），1 例角膜溃疡，7 例干眼症，1 例°IV 出血，2 例组织坏死，其他无明显迟发性反应。客观缓解率（CR/PR）为 56.6%。中位随访 14 个月[1-39 个月]后，1a 时局部控制率和远处控制率分别为 70.3%和 72.6%。在 18 例局部复发患者中，13 例在野内复发，1 例在野边缘，3 例在野外，1 例在剂量梯度内。
结论
尽管应用了高剂量，但 C12 再放疗的副作用适中，即使在这些接受过大量预处理的患者中，缓解率也令人鼓舞，是姑息性化疗的良好替代方法。尽管大多数局部复发发生在高剂量区域内，但应谨慎考虑进一步增加剂量。
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