Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Jun 18;49(3):547-580.
To investigate clinical features of distant metastases from malignant salivary gland carcinomas after treated by I internal brachy therapy alone.
Between 2002 and 2010, 43 patients with locally advanced unresectable or recurrent malignant salivary gland carcinomas were treated by I internal brachy therapy alone at Peking University School and Hospital of Stomatology. All of them had been follow-up at least 2 years. The primary sites of malignant salivary gland carcinomas were the parotid for 12 patients, infratemporal fossa for 9 patients, tongue for 7 patients, maxilla for 6 patients, parapharyngeal for 4 patients, floor of months for 3 patients, submandibular gland for 1 patient, and lip for 1 patient. The overall survival rate, local control rate, and distant metastases were retrospectively reviewed.
Distant metastases occurred in 23 of the 43 patients (53.5%). Distant metastases developed from 5 to 96 months, with an average interval of (27.0±23.7) months from the time of initial diagnosis, the mean interval was 21 months. The commonest site of distant metastases overall was the lung 69.6%(16/23). The most common pathological types of distant metastases were adenoid cystic carcinoma (14/23, 60.9%) and nonspecific adenocarcinoma (7/23, 30.4%). At the time of the last follow-up, 26 patients died, and 18 of them due to distant metastases (69.2%, 18/26). In the study, 27 patients got complete remission(CR), 12 got partial remission(PR) more than 50%, 2 less than 50%, and 2 patients were invalid. The effective rate (CR+ PR) was 90.7%. The 3 year loco-regional control rate and survival rate were 60.1%, 82.6%, respectively, and the 5 year's 53.4% and 56.0%.
The I brachy therapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent malignant salivary gland carcinomas. However, further studies are needed with larger numbers of patients and for a longer follow-up assessment. Distant metastasis was the main cause of treatment failure, and the lung was the most common site of distant metastases.
探讨单纯碘粒子组织间插植近距离治疗后涎腺恶性肿瘤远处转移的临床特点。
2002年至2010年，北京大学口腔医学院口腔颌面外科对43例局部晚期无法手术切除或复发的涎腺恶性肿瘤患者进行单纯碘粒子组织间插植近距离治疗。所有患者均随访至少2年。涎腺恶性肿瘤的原发部位：腮腺12例，颞下窝9例，舌7例，上颌骨6例，咽旁4例，口底3例，下颌下腺1例，唇1例。回顾性分析患者的总生存率、局部控制率及远处转移情况。
43例患者中23例（53.5%）发生远处转移。远处转移发生于初次诊断后5至96个月，平均间隔时间为（27.0±23.7）个月，中位间隔时间为21个月。远处转移最常见的部位是肺，占69.6%（16/23）。远处转移最常见的病理类型是腺样囊性癌（14/23，60.9%）和非特异性腺癌（7/23，30.4%）。末次随访时，26例患者死亡，其中18例死于远处转移（69.2%，18/26）。本研究中，27例患者获得完全缓解（CR），12例获得部分缓解（PR）且缓解率大于50%，2例缓解率小于50%，2例无效。有效率（CR+PR）为90.7%。3年局部区域控制率和生存率分别为60.1%、82.6%，5年局部区域控制率和生存率分别为53.4%、56.0%。
碘粒子组织间插植近距离治疗是治疗局部晚期无法手术切除或复发涎腺恶性肿瘤的一种可行且有效的方法。然而，需要进一步开展更大样本量、更长随访时间的研究。远处转移是治疗失败的主要原因，肺是最常见的远处转移部位。
