Li C, Liu S M, Zheng L, Huang M W, Shi Y, Lv X M, Zhang J G, Zhang J
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Feb 18;51(1):49-52. doi: 10.19723/j.issn.1671-167X.2019.01.009.
To retrospectively analyze the results of treatment outcome by surgery combined with I brachytherapy and correlative factors of adenoid cystic carcinoma (ACC).
In the study, 75 patients with primary ACC of oral and maxillofacial region were treated by surgery combined with I seeds brachytherapy. Radical resection or subtotal resection was applied for the tumor. The brachytherapy treatment planning system was used to create implant plans with the prescribed dose of 60 Gy to 120 Gy. The I seeds were implanted intraoperatively or postoperatively. The regular follow-up was required. The Kaplan-Meier method was used to assess the tumor control rate and the patients' survival rates. Meanwhile, the Cox regression analysis was used to find out the prognostic factors.
Local control rates at the end of 3 and 5 years were as follows: T1-T2, 92.2% and 82.0%; T3-T4, 82.6% and 82.6%; and overall, 90.0% and 78.8%. The disease-free survival rates were 74.9% and 54.3%, respectively. The overall survival rates for all the patients were 86.0% and 79.6%, respectively at the end of 3 and 5 years and were 91.3% and 91.3% for T1-T2 patients vs. 73.9% and 59.7% for T3-T4 patients. Distant metastasis-free survival rates at the end of 3 and 5 years were 84.4% and 76.7%, respectively. The distant metastasis-free survival rates at the end of 3 and 5 years were 83.4% and 79.6% with T1-T2 lesion compared with 86.0% and 67.8% with T3-T4 lesion. According to the COX univariate analysis and multivariate analysis, the risk of local recurrence would be raised by the age. Tumor stage and tumor site were the prognostic factors of the overall survival rates.
I brachytherapy conducted as an adjuvant therapy postoperatively of ACC of oral and maxillofacial region can acquire satisfactory localregional control, distant metastasis-free survival, disease-free survival and overall survival. Tumors are prone to recur on the older patients. Patients having advanced tumor stage or tumor located in the nasal cavity or sinuses will suffer lower survival rates.
回顾性分析手术联合碘粒子近距离治疗腺样囊性癌（ACC）的治疗效果及相关因素。
本研究中，75例口腔颌面部原发性ACC患者接受了手术联合碘粒子近距离治疗。对肿瘤行根治性切除或次全切除。采用近距离治疗计划系统制定植入计划，规定剂量为60 Gy至120 Gy。碘粒子在术中或术后植入。需定期随访。采用Kaplan-Meier法评估肿瘤控制率和患者生存率。同时，采用Cox回归分析找出预后因素。
3年和5年末的局部控制率如下：T1-T2期分别为92.2%和82.0%；T3-T4期分别为82.6%和82.6%；总体分别为90.0%和78.8%。无病生存率分别为74.9%和54.3%。所有患者的总生存率在3年和5年末分别为86.0%和79.6%，T1-T2期患者分别为91.3%和91.3%，T3-T4期患者分别为73.9%和59.7%。3年和5年末的无远处转移生存率分别为84.4%和76.7%。T1-T2期病变3年和5年末的无远处转移生存率分别为83.4%和79.6%，T3-T4期病变分别为86.0%和67.8%。根据COX单因素分析和多因素分析，年龄会增加局部复发风险。肿瘤分期和肿瘤部位是总生存率的预后因素。
口腔颌面部ACC术后行碘粒子近距离治疗作为辅助治疗可获得满意的局部区域控制、无远处转移生存、无病生存和总生存。老年患者肿瘤易复发。肿瘤分期较晚或肿瘤位于鼻腔或鼻窦的患者生存率较低。
