Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054, Erlangen, Germany.
Department of Otorhinolaryngology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Radiat Oncol. 2019 Apr 23;14(1):68. doi: 10.1186/s13014-019-1260-x.
The aim was to evaluate the outcome, especially locoregional control of patients with locally advanced salivary gland carcinoma (SGC) with perineural spread (Pn1) and/or positive resection margins (R1/2) after postoperative photon (chemo) radiotherapy in a single centre.
We retrospectively reviewed data of 65 patients with newly diagnosed locally advanced SGC without distant metastases who underwent radio (chemo) therapy in the department of radiation oncology of the university hospital of Erlangen from January 2000 until April 2017. Kaplan Meier method was used to calculate survival and recurrence rates. In univariate analysis the log-rank test was used to correlate patient-/tumor- and treatment-related parameters to survival and recurrence rates.
Median follow-up was 45 months (range: 6; 215). After 1, 3, 5 years cumulative incidence of local and locoregional failure was 3.1, 7.0, 7.0% and 3.1, 9.7, 12.9%, whereas cumulative incidence of distant metastases (DM) was 15.6, 36.0, 44.0%. After 1,3, 5 years cumulative Overall (OS) and Disease-free survival (DFS) was 90.5, 74.9, 63.9% and 83.0, 54.8, 49.4%. The only significant predictor for decreased local and locoregional control was a macroscopic resection margin(R2) (p = 0.002 and p = 0.04). High-grade histology (p = 0.006), lymph node metastases with extracapsular spread (p = 0.044) and an advanced T-stage (p = 0.031) were associated with an increased rate of DM. High-grade histology was the only factor predicting for a decreased DFS (p = 0.014).
Photon radiotherapy leads to high local and locoregional control rates in a high-risk patient population with SGC with microscopically positive resection margins and/or perineural spread. The most common site of disease recurrence was distant metastases. Therefore the real challenge for the future should be to prevent distant metastases.
本研究旨在评估单一中心接受术后光子（放化疗）放疗的局部晚期唾液腺癌（SGC）伴神经周围侵犯（Pn1）和/或阳性切缘（R1/2）患者的预后，特别是局部区域控制情况。
我们回顾性分析了 2000 年 1 月至 2017 年 4 月期间在埃尔兰根大学医院放射肿瘤科接受放化疗的 65 例局部晚期 SGC 且无远处转移的新诊断患者的资料。采用 Kaplan-Meier 法计算生存率和复发率。单因素分析采用对数秩检验，分析与患者/肿瘤和治疗相关的参数与生存率和复发率的相关性。
中位随访时间为 45 个月（范围：6~215）。1、3、5 年局部和局部区域失败的累积发生率分别为 3.1%、7.0%、7.0%和 3.1%、9.7%、12.9%，而远处转移（DM）的累积发生率分别为 15.6%、36.0%、44.0%。1、3、5 年的总生存率（OS）和无病生存率（DFS）分别为 90.5%、74.9%、63.9%和 83.0%、54.8%、49.4%。仅有肉眼切缘（R2）（p=0.002 和 p=0.04）是局部和局部区域控制降低的唯一显著预测因素。高级别组织学（p=0.006）、淋巴结转移伴包膜外扩散（p=0.044）和晚期 T 分期（p=0.031）与 DM 发生率增加相关。高级别组织学是唯一预测 DFS 降低的因素（p=0.014）。
光子放疗可使局部晚期 SGC 伴显微镜下阳性切缘和/或神经周围侵犯的高危患者获得较高的局部和局部区域控制率。疾病复发的最常见部位是远处转移。因此，未来的真正挑战应该是预防远处转移。
