Miyoshi Shota, Nishibuchi Ikuno, Ochi Hiroki, Sakauchi Hiroshi, Tani Shigeyuki, Katsuta Tsuyoshi, Imano Nobuki, Hirokawa Junichi, Hamamoto Takao, Ueda Tsutomu, Murakami Yuji
Department of Radiation Oncology, Hiroshima City North Medical Center, Asa Citizens Hospital, 2-1-1 kabeminami, asakita-ku, Hiroshima 731-0293, Japan.
Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Jpn J Clin Oncol. 2025 Jul 6;55(7):751-757. doi: 10.1093/jjco/hyaf068.
Surgery is the standard of care for major salivary gland carcinoma (MSGC), and postoperative radiotherapy (PORT) is used for patients at high risk of postoperative recurrence.
We retrospectively analyzed 32 patients with MSGC treated with PORT between 2010 and 2019. All patients had one or more of the following high-risk factors for recurrence: histologically high-grade, T3-4 tumors, positive or close margins, lymph node (LN) metastasis, and perineural invasion.
The median age of the patients was 63 years (range, 18-81 years). Stage I, II, III, and IV disease were observed in 2, 5, 7, and 18 patients, respectively. Twenty-two patients underwent concurrent systemic therapy. The most commonly irradiated areas were the primary lesion and ipsilateral neck (78%). The 5-year overall survival (OS), recurrence-free survival (RFS) and locoregional control rates were 49%, 31%, and 77%, respectively. The 5-year OS rates were 86% for Stages I-III, and 22% for Stage IV. The 5-year RFS rates were 57% for Stages I-III, and 11% for Stage IV. Recurrence occurred in 22 patients. The most common pattern of recurrence was pulmonary metastases (34%). There were seven cases of cervical LN metastasis at the time of first recurrence, and five of these cases showed cervical LN metastases outside the irradiated area.
We reported the results of PORT in patients with MSGC. Although the incidence of in-field recurrence was low, recurrence from outside the irradiated area was common, suggesting the need for further investigation into the optimal systemic therapy and radiation extent.
手术是治疗大涎腺癌（MSGC）的标准治疗方法，术后放疗（PORT）用于术后复发风险高的患者。
我们回顾性分析了2010年至2019年间接受PORT治疗的32例MSGC患者。所有患者均有以下一种或多种复发高危因素：组织学高级别、T3-4期肿瘤、切缘阳性或接近切缘、淋巴结（LN）转移和神经周围浸润。
患者的中位年龄为63岁（范围18-81岁）。分别有2、5、7和18例患者为Ⅰ、Ⅱ、Ⅲ和Ⅳ期疾病。22例患者接受了同步全身治疗。最常照射的部位是原发灶和同侧颈部（78%）。5年总生存率（OS）、无复发生存率（RFS）和局部区域控制率分别为49%、31%和77%。Ⅰ-Ⅲ期的5年OS率为86%，Ⅳ期为22%。Ⅰ-Ⅲ期的5年RFS率为57%，Ⅳ期为11%。22例患者出现复发。最常见的复发模式是肺转移（34%）。首次复发时有7例颈部LN转移，其中5例在照射区域外出现颈部LN转移。
我们报告了MSGC患者PORT的结果。尽管野内复发的发生率较低，但照射区域外的复发很常见，提示需要进一步研究最佳的全身治疗和放疗范围。
