Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P. R. China.
Pediatr Blood Cancer. 2020 Jul;67(7):e28343. doi: 10.1002/pbc.28343. Epub 2020 May 11.
Acinic cell carcinoma (AciCC) is rare in children; therefore, reaching a consensus on its management is challenging and radiotherapy is limited by concerns about long-term toxicity. The purpose of this study is to analyze the effectiveness and safety of surgery plus postoperative I interstitial brachytherapy (IBT) for children and adolescents with AciCC of the parotid gland (PG) treated at a single institution.
Sixteen patients ≤ 18 years old with AciCC of the PG treated with surgery plus I IBT from 2007 to 2018 were included. Surgery was the primary treatment; ten patients underwent total gross excision and six subtotal gross excision. The matched peripheral dose was 60-120 Gy. Overall survival, disease-free survival (DFS), local control rate, distant metastasis, and radiation-associated toxicities were analyzed, and factors influencing outcomes were evaluated.
During follow-up (1.8-12.6 years; mean, 6.3 years), lymph node metastasis was observed in one case, 2.6 years after I IBT treatment. The five-year overall and DFS rates were 100% and 91.7%, respectively. On univariate analysis, tumor size ≥ 3 cm (100% vs 50%; P = 0.025) and extraglandular extension (100% vs 50%; P = 0.025) were significant prognostic indicators for DFS. No severe radiation-associated complications occurred.
Children and adolescents with AciCC of the PG with high-risk features can be managed using surgery plus postoperative I IBT with excellent local control. Radiation-related complications were minor. Patients with facial nerve involvement can have their facial nerves preserved. Residual tumors can be safely managed using adjuvant I IBT.
涎腺腺样囊性癌（AciCC）在儿童中较为罕见；因此，针对其治疗方法达成共识具有挑战性，且放疗受到长期毒性的担忧的限制。本研究旨在分析单中心治疗的儿童和青少年腮腺（PG）AciCC 患者采用手术加术后 I 间质内近距离放疗（IBT）的有效性和安全性。
纳入 2007 年至 2018 年期间接受手术加 I IBT 治疗的 16 例≤18 岁的 PG 腺样囊性癌患者。手术是主要治疗方法；10 例患者行全切除，6 例患者行次全切除。匹配周边剂量为 60-120Gy。分析总生存率、无疾病生存率（DFS）、局部控制率、远处转移和放疗相关毒性，评估影响结果的因素。
在随访期间（1.8-12.6 年；平均 6.3 年），1 例患者在 I IBT 治疗后 2.6 年出现淋巴结转移。5 年总生存率和 DFS 率分别为 100%和 91.7%。单因素分析显示，肿瘤大小≥3cm（100%比 50%；P=0.025）和外生扩展（100%比 50%；P=0.025）是 DFS 的显著预后指标。未发生严重的放疗相关并发症。
对于具有高危特征的儿童和青少年 PG 腺样囊性癌患者，可以采用手术加术后 I IBT 治疗，局部控制效果良好。放疗相关并发症较小。面神经受累的患者可以保留面神经。残留肿瘤可以安全地采用辅助 I IBT 治疗。
