Tran L, Sadeghi A, Hanson D, Juillard G, Mackintosh R, Calcaterra T C, Parker R G
Laryngoscope. 1986 Oct;96(10):1139-44. doi: 10.1288/00005537-198610000-00014.
A retrospective review of 133 patients with major salivary gland carcinomas treated between 1955 and 1981 is presented. The majority of cases (104) originated in the parotid gland. The most common histological type was mucoepidermoid carcinoma (39 cases). Tumor-free interval was longest for patients with acinic cell and mucoepidermoid carcinomas. In contrast, adenoid cystic carcinoma was poorly controlled, regardless of the form of treatment. Initial control of primary major salivary gland tumors was inversely related to the presence of disease at the surgical margins. In cases with microscopic or gross disease at the surgical margins, postoperative radiation therapy controlled the tumor locally in 18 of 26 patients (69%). Postoperative radiation therapy was generally used only in cases with high-grade histologies, advanced stages, or positive surgical margins. Of the patients treated with surgery alone, 53% achieved local control, as compared to 75% of the group which received postoperative radiation therapy. Although the difference was not statistically significant, we would have expected the combined therapy group to have a lower control rate due to more advanced disease. There was a low salvage rate (22%) and a high incidence of distant metastasis (60%) in recurrent cases. The data indicates that complete surgical resection results in the best local control, with or without adjuvant radiation. When the surgical margin is inadequate and re-excision not possible, adjuvant radiation therapy appears to have a role to optimize local control and survival.
本文对1955年至1981年间接受治疗的133例大唾液腺癌患者进行了回顾性研究。大多数病例（104例）起源于腮腺。最常见的组织学类型是黏液表皮样癌（39例）。腺泡细胞癌和黏液表皮样癌患者的无瘤间期最长。相比之下，腺样囊性癌无论采用何种治疗方式，控制效果都较差。大唾液腺原发性肿瘤的初始控制与手术切缘有无病变呈负相关。在手术切缘有显微镜下或肉眼可见病变的病例中，术后放射治疗使26例患者中的18例（69%）肿瘤得到局部控制。术后放射治疗一般仅用于组织学分级高、分期晚或手术切缘阳性的病例。单纯接受手术治疗的患者中，53%实现了局部控制，而接受术后放射治疗的患者组这一比例为75%。尽管差异无统计学意义，但由于疾病更晚期，我们原本预计联合治疗组的控制率会更低。复发病例的挽救率较低（22%），远处转移发生率较高（60%）。数据表明，完整的手术切除，无论有无辅助放疗，都能实现最佳的局部控制。当手术切缘不充分且无法再次切除时，辅助放射治疗似乎有助于优化局部控制和提高生存率。
