唾液腺癌术后放疗：单机构经验
Postoperative Radiotherapy in Salivary Gland Carcinoma: A Single Institution Experience.
作者信息
Temelli Öztun, Kekilli Ersoy, Kizilay Ahmet
机构信息
Department of Radiation Oncology, School of Medicine, Inonu University, Malatya, Turkey.
Department of Nuclear Medicine, School of Medicine, Inonu University, Malatya, Turkey.
出版信息
Gulf J Oncolog. 2017 Jan;1(23):26-32.
BACKGROUND
Salivary gland carcinoma are rare tumors and the main treatment is surgical. The addition of radiotherapy to surgery decreases locoregional relapses in high risk patients. Aim of our study is to retrospectively evaluate local control and survival and the factors affecting them in patients who received postoperative radiotherapy.
MATERIALS AND METHODS
The medical records of 30 patients with salivary gland tumors operated on and referred to our clinic for adjuvant RT between January 2004 and June 2015 were retrospectively evaluated. RT was applied to the primary tumor or its lymphatics in a median dose of 60 Gy (48-66 Gy) in 1.8-2 Gy/fraction. The number of patients receiving concomitant chemotherapy was 8 (27%) and 22 (73%), respectively.
RESULTS
The mean duration of follow-up was 47 months (range: 3-132 months). The mean duration between surgery and RT was 51 days and mean duration of RT was 43 days. Tumors were located in the parotid gland in 25 patients (83%), in the submandibular gland in four patients (14%), and in the sublingual gland in one patient (3%). Histopathologically, the most common tumor was adenoid cystic carcinoma (27%), followed by mucoepidermoid carcinoma (20%), and skin SCC metastatic to the parotid gland. Five-year overall survival (OS), five-year disease specific survival (DSS), and five-year disease free survival (DFS) were 50%, 50%, and 54%, respectively. Regional recurrence and distant organ metastasis developed in 5 (17%) and 9 (30%) patients, respectively. OS, DSS, and DFS were significantly decreased in patients with lymph node metastasis compared to the patients with no metastasis (p=0.002). DFS was better in Stage 1-2 patients compared to Stage 3-4 patients (p=0.019). OS and DFS were significantly in radiotherapy time in less than 45 days (p=0.01). A duration between surgery and radiotherapy of more than 42 days was associated with low DFS (p=0.042). No prognostic significance of age, gender, type of the salivary gland, T stage, tumor diameter, surgical margin, PNI, LVI, and extracapsular involvement was found among the other variables.
CONCLUSION
Adjuvant RT is an efficacious and safe method of treatment in high risk patients operated on for salivary gland tumor.
背景
涎腺癌是罕见肿瘤，主要治疗方法是手术。对高危患者在手术基础上加用放疗可降低局部区域复发率。本研究的目的是回顾性评估接受术后放疗患者的局部控制率、生存率以及影响它们的因素。
材料与方法
回顾性评估2004年1月至2015年6月间30例接受涎腺肿瘤手术并转诊至我院进行辅助放疗的患者的病历。对原发肿瘤或其淋巴管进行放疗，中位剂量为60 Gy（48 - 66 Gy），每次分割剂量为1.8 - 2 Gy。接受同步化疗的患者分别为8例（27%）和22例（73%）。
结果
平均随访时间为47个月（范围：3 - 132个月）。手术与放疗之间的平均间隔时间为51天，放疗平均持续时间为43天。25例（83%）肿瘤位于腮腺，4例（14%）位于下颌下腺，1例（3%）位于舌下腺。组织病理学上，最常见的肿瘤是腺样囊性癌（27%），其次是黏液表皮样癌（20%），以及转移至腮腺的皮肤鳞状细胞癌。5年总生存率（OS）、5年疾病特异性生存率（DSS）和5年无病生存率（DFS）分别为50%、50%和54%。分别有5例（17%）和9例（30%）患者发生区域复发和远处器官转移。与无淋巴结转移的患者相比，有淋巴结转移的患者OS、DSS和DFS显著降低（p = 0.002）。1 - 2期患者的DFS优于3 - 4期患者（p = 0.019）。放疗时间少于45天的患者OS和DFS显著降低（p = 0.01）。手术与放疗间隔时间超过42天与低DFS相关（p = 0.042）。在其他变量中，未发现年龄、性别、涎腺类型、T分期、肿瘤直径、手术切缘、神经周浸润、脉管浸润和包膜外侵犯具有预后意义。
结论
辅助放疗是对接受涎腺肿瘤手术的高危患者一种有效且安全的治疗方法。
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