Saitoh Jun-Ichi, Koto Masashi, Demizu Yusuke, Suefuji Hiroaki, Ohno Tatsuya, Tsuji Hiroshi, Okimoto Tomoaki, Shioyama Yoshiyuki, Nemoto Kenji, Nakano Takashi, Kamada Tadashi
Gunma University Heavy Ion Medical Center, Maebashi, Japan.
Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.
Int J Radiat Oncol Biol Phys. 2017 Oct 1;99(2):442-449. doi: 10.1016/j.ijrobp.2017.04.032. Epub 2017 May 3.
Head and neck (HN) adenocarcinoma is rare, and to date, there have been no reports of prospective studies. We retrospectively evaluated the efficacy and safety of carbon-ion radiation therapy (C-ion RT) for HN adenocarcinoma in institutions in Japan.
HN adenocarcinoma patients with N0M0 or N1M0 disease who were treated with C-ion RT at institutions in Japan between November 2003 and December 2014 were analyzed retrospectively. We enrolled 47 patients (30 male and 17 female patients; median age, 60 years) with HN adenocarcinoma.
Primary sites included the nasal and paranasal sinus in 21 patients, orbit in 11, salivary grand in 7, oral cavity and pharynx in 6, and acoustic organ in 2. Thirty-two patients had T4 tumors, 6 had T3, and 6 had T2. Forty-five patients received a diagnosis of N0 disease, whereas 2 had N1 disease. The median total dose of C-ion RT and the number of fractions were 64.0 Gy (relative biological effectiveness) and 16 fractions, respectively. The median follow-up period was 51 months (range, 6-118 months). The 2- and 5-year overall survival rates were 87.9% and 60.4%, respectively, and the 2- and 5-year local control rates were 83.3% and 79.3%, respectively. Multivariate analysis showed that operability (patients with operable tumors) (P=.045) and fractionation (16 fractions) (P=.010) were significant independent prognostic factors for better overall survival. No grade 5 late morbidities were observed. Grade 4 late morbidities were observed in 4 patients, and all of these grade 4 morbidities were visual impairments. All 4 patients with grade 4 visual impairment had T4 tumors in the nasopharynx or paranasal sinuses, which implied inoperable tumors with orbital or brain invasion.
C-ion RT resulted in excellent local control. C-ion RT could become a curative treatment option for HN adenocarcinoma with acceptable toxicities.
头颈部腺癌较为罕见，迄今为止，尚无前瞻性研究报告。我们回顾性评估了日本各机构中碳离子放射治疗（C离子放疗）对头颈部腺癌的疗效和安全性。
对2003年11月至2014年12月期间在日本各机构接受C离子放疗的N0M0或N1M0期头颈部腺癌患者进行回顾性分析。我们纳入了47名头颈部腺癌患者（30例男性和17例女性患者；中位年龄60岁）。
原发部位包括21例患者的鼻腔和鼻窦、11例眼眶、7例唾液腺、6例口腔和咽部以及2例听器官。32例患者为T4期肿瘤，6例为T3期，6例为T2期。45例患者诊断为N0期疾病，2例为N1期疾病。C离子放疗的中位总剂量和分次次数分别为64.0 Gy（相对生物效应）和16次。中位随访期为51个月（范围6 - 118个月）。2年和5年总生存率分别为87.9%和60.4%，2年和5年局部控制率分别为83.3%和79.3%。多因素分析显示，可手术性（可手术肿瘤患者）（P = 0.045）和分次次数（16次）（P = 0.010）是总体生存更好的显著独立预后因素。未观察到5级晚期并发症。4例患者出现4级晚期并发症，所有这些4级并发症均为视力损害。所有4例4级视力损害患者的鼻咽或鼻窦均为T4期肿瘤，这意味着肿瘤无法手术且侵犯眼眶或脑。
C离子放疗可实现出色的局部控制。C离子放疗可能成为毒性可接受的头颈部腺癌的一种根治性治疗选择。
