Xu Ning, Zheng Lei, Wu Wen-Jie, Huang Ming-Wei, Zhang Jie, Zhang Jian-Guo
Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
J Oral Maxillofac Surg. 2019 Oct;77(10):2143-2153. doi: 10.1016/j.joms.2019.03.031. Epub 2019 Mar 30.
Adenoid cystic carcinoma (ACC) involving the skull base is difficult to treat and sometimes unresectable. The purpose of this study was to evaluate the efficacy and safety of I radioactive seed interstitial brachytherapy for treatment of these patients.
Patients with ACC involving the skull base treated by definitive I brachytherapy from March 2008 through December 2018 at the Peking University Hospital of Stomatology (Beijing, China) were retrospectively identified. Overall survival (OS), as the primary efficacy indicator, and progression-free survival (PFS) and distant metastasis-free survival (DFS), as the secondary efficacy indicators, were analyzed by Kaplan-Meier survival analysis and Cox regression analysis. Adverse radiotherapy (RT) reactions, as safety indicators, were recorded.
Thirty-two patients with (r)T4b locally advanced disease were enrolled. The prescription dose (PD) was 60 to 120 Gy. The dose delivered to 90% of the target volume was 99.1 to 145.2 Gy, the percentage of the target volume receiving at least 100% of the PD was at least 88.2%, and the percentage of the target volume receiving at least 150% of the PD was smaller than 74.0%. Mean follow-up was 32 months (median, 21 months; range, 3 to 95 months). The 1- and 3-year OS rates were 93.3 and 62.6%, the 1- and 3-year PFS rates were 90.0 and 46.4%, and the 1- and 3-year DFS rates were 91.7 and 61.1%, respectively. Survival was significantly associated with local recurrence (P = .04) and distant metastasis except in the lung (P = .05). The rate of severe chronic adverse RT reactions was 3.1%; no severe acute adverse RT reactions were observed.
I brachytherapy appears to be an effective and safe treatment in the short-term for ACC involving the skull base and could be the preferred treatment for patients with prior RT. Local control with brachytherapy could provide survival benefit even in patients with lung metastasis.
累及颅底的腺样囊性癌（ACC）难以治疗，有时无法切除。本研究的目的是评估放射性碘粒子组织间近距离放射治疗对这些患者的疗效和安全性。
回顾性纳入2008年3月至2018年12月期间于北京大学口腔医院（中国北京）接受确定性碘近距离放射治疗的累及颅底的ACC患者。采用Kaplan-Meier生存分析和Cox回归分析对总生存（OS）作为主要疗效指标、无进展生存（PFS）和无远处转移生存（DFS）作为次要疗效指标进行分析。记录放疗不良反应作为安全指标。
纳入32例（r）T4b局部晚期疾病患者。处方剂量（PD）为60至120 Gy。给予靶体积90%的剂量为99.1至145.2 Gy，接受至少100%PD的靶体积百分比至少为88.2%，接受至少150%PD的靶体积百分比小于74.0%。平均随访32个月（中位数，21个月；范围，3至95个月）。1年和3年OS率分别为93.3%和62.6%，1年和3年PFS率分别为90.0%和46.4%，1年和3年DFS率分别为91.7%和61.1%。生存与局部复发（P = .04）和除肺部外的远处转移显著相关（P = .05）。严重慢性放疗不良反应发生率为3.1%；未观察到严重急性放疗不良反应。
放射性碘近距离放射治疗短期内似乎是治疗累及颅底ACC的一种有效且安全的方法，可能是既往接受过放疗患者的首选治疗方法。即使对于有肺转移的患者，近距离放射治疗的局部控制也能带来生存获益。
