Ellis E R, Million R R, Mendenhall W M, Parsons J T, Cassisi N J
Dept. of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):613-7. doi: 10.1016/0360-3016(88)90302-1.
Between 1964 and 1985, 52 patients were treated with curative intent by radiation therapy alone or in combination with surgery for malignant tumors of minor salivary gland origin. All patients had a minimum follow-up of 2 years, and 80% had a minimum follow-up of 5 years. Twenty-six (50%) were adenoid cystic carcinomas; the remaining histologies included adenocarcinoma, mucoepidermoid carcinoma, and malignant mixed tumors. The most common sites of origin were in the oral cavity/oropharynx (49%) and the nasal cavity or paranasal sinuses (40%). Twenty-seven patients (52%) presented with an advanced or unresectable stage (AJCC Stage III or IV, extensive bone or nerve invasion, or tumor greater than 5 cm). Treatment was highly individualized; 50% of the patients received radiation therapy alone, and 50% received combined treatment with either postoperative or preoperative radiation therapy. Early-stage minor salivary gland tumors were controlled equally well with radiation therapy alone or with a combined approach. For the advanced tumors, a combined approach yielded significantly superior absolute local control rates as compared with radiation therapy alone (10/13 vs. 2/13). For adenoid cystic carcinoma, the local control rate at 10 years was 45% (actuarial); the tumor was not controlled locally in any patients with advanced/unresectable stage who were treated with radiation therapy alone. The absolute local control rate was 75% for 4 early-stage tumors treated with radiation therapy alone and 60% for 5 advanced tumors treated with a combined approach. The average time to local recurrence was 67 months for adenoid cystic carcinoma. Severe complications of radiation therapy occurred in 11 (27%) of 40 evaluable patients, with unilateral blindness being the most common. Seven of 9 patients who became blind had unresectable disease with close proximity to or invasion of the orbit. A time-dose analysis is also presented.
1964年至1985年间，52例起源于小唾液腺的恶性肿瘤患者接受了单纯放疗或放疗联合手术的根治性治疗。所有患者至少随访2年，80%的患者至少随访5年。26例（50%）为腺样囊性癌；其余组织学类型包括腺癌、黏液表皮样癌和恶性混合瘤。最常见的起源部位是口腔/口咽（49%）和鼻腔或鼻窦（40%）。27例患者（52%）表现为晚期或不可切除阶段（美国癌症联合委员会III期或IV期、广泛的骨或神经侵犯或肿瘤大于5 cm）。治疗高度个体化；50%的患者接受单纯放疗，50%的患者接受术后或术前放疗的联合治疗。早期小唾液腺肿瘤单纯放疗或联合治疗的控制效果相当。对于晚期肿瘤，联合治疗与单纯放疗相比，绝对局部控制率显著更高（10/13对2/13）。对于腺样囊性癌，10年局部控制率为45%（精算）；单纯放疗的晚期/不可切除阶段的任何患者肿瘤均未得到局部控制。4例早期肿瘤单纯放疗的绝对局部控制率为75%，5例晚期肿瘤联合治疗的绝对局部控制率为60%。腺样囊性癌局部复发的平均时间为67个月。40例可评估患者中有11例（27%）发生了严重的放疗并发症，最常见的是单侧失明。9例失明患者中有7例患有不可切除的疾病，肿瘤紧邻眼眶或侵犯眼眶。还进行了时间-剂量分析。
