Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Med Radiat Sci. 2023 Jun;70(2):161-170. doi: 10.1002/jmrs.650. Epub 2023 Feb 15.
Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy technique, dose and volumes are seldom described sufficiently to allow close examination. We report our treatment outcomes and focus on treatment-related factors that affect outcomes in this cohort.
We performed a retrospective review of patients with metastatic cutaneous SCCs who underwent parotidectomy with or without ipsilateral neck dissection. All patients received adjuvant radiotherapy. Demographics, clinical data and treatment details were collected from an intuitional electronic database. Individual patient-level radiotherapy technique, volumes and doses were reviewed.
Between July 2008 and July 2018, 60 patients met our inclusion criteria. Median follow-up duration was 32.7 months. The mean age was 66.4 years. The majority of patients (49 patients) received full neck irradiation. The 2-year and 5-year loco-regional failure-free survival was 87% (95% confidence interval (CI): 0.74-0.93) and 71% (95% CI: 0.52, 0.83), respectively. The 2-year and 5-year overall survival was 76% (95% CI: 0.62, 0.85) and 60% (95% CI: 0.45, 0.72), respectively. There were 15 cases of loco-regional failures, with 6 cases with dermal involvement. Lymphovascular invasion (LVI) was associated with higher loco-regional failure (hazard ratio: 8.43, 95% CI: 1.85-38.39, P = 0.005) and cancer-specific mortality (hazard ratio: 5.40, 95% CI: 1.40-20.87, P = 0.015). Treatment technique, intensity-modulated radiation therapy (IMRT) vs 3D conformal radiotherapy (3D CRT), bolus use, perineural invasion (PNI) and surgical margins were not significantly associated with loco-regional failure.
We demonstrated high loco-regional control rates with routine use of comprehensive adjuvant radiotherapy. The presence of LVI was identified as a strong predictor for recurrence. Further analysis will help to define optimal radiation dose and techniques.
辅助放疗是治疗涉及腮腺的转移性皮肤鳞状细胞癌（SCC）的既定组成部分。放疗技术、剂量和体积很少有足够的描述，难以进行仔细检查。我们报告了我们的治疗结果，并重点介绍了影响该队列治疗结果的治疗相关因素。
我们对接受腮腺切除术伴或不伴同侧颈部清扫术的转移性皮肤 SCC 患者进行了回顾性研究。所有患者均接受辅助放疗。从机构电子数据库中收集患者的人口统计学、临床数据和治疗细节。对每位患者的个体化放疗技术、剂量和体积进行了评估。
2008 年 7 月至 2018 年 7 月期间，共有 60 名患者符合纳入标准。中位随访时间为 32.7 个月。患者的平均年龄为 66.4 岁。大多数患者（49 例）接受了全颈部照射。2 年和 5 年的局部区域无复发生存率分别为 87%（95%置信区间：0.74-0.93）和 71%（95%置信区间：0.52，0.83）。2 年和 5 年的总生存率分别为 76%（95%置信区间：0.62，0.85）和 60%（95%置信区间：0.45，0.72）。有 15 例局部区域复发，其中 6 例有皮肤受累。淋巴血管侵犯（LVI）与较高的局部区域复发相关（风险比：8.43，95%置信区间：1.85-38.39，P=0.005）和癌症特异性死亡率（风险比：5.40，95%置信区间：1.40-20.87，P=0.015）。治疗技术（调强放疗[IMRT]与三维适形放疗[3D CRT]）、使用填充物、神经周围侵犯（PNI）和手术切缘与局部区域复发无显著相关性。
我们常规使用综合辅助放疗，取得了较高的局部区域控制率。LVI 的存在被确定为复发的强烈预测因素。进一步的分析将有助于确定最佳的放疗剂量和技术。
