Douglas J G, Laramore G E, Austin-Seymour M, Koh W J, Lindsley K L, Cho P, Griffin T W
Department of Radiation, University of Washington Medical Center, Seattle 98195-6043, USA.
Int J Radiat Oncol Biol Phys. 1996 Aug 1;36(1):87-93. doi: 10.1016/s0360-3016(96)00213-1.
To examine the efficacy of fast neutron radiotherapy for the treatment of patients with locally advanced, adenoid cystic carcinoma of minor salivary glands and to identify prognostic variables associated with local control, overall survival, and cause specific survival.
Eighty-four patients having adenoid cystic carcinoma of minor salivary glands were treated with fast neutron radiotherapy during the years 1985-1994. All patients had either unresectable disease or gross disease remaining after attempted surgical extirpation. Seventeen patients had previously received conventional radiotherapy and their subsequent treatment fields and doses for neutron radiotherapy were modified for critical sites (brainstem, spinal cord, brain). Although the median doses (tumor maximum and tumor minimum) only varied by < or = 10%, treatment portals were substantially smaller in these patients because of normal tissue complication considerations. Twelve patients (13%) had distant metastases at the time of treatment and were only treated palliatively with smaller treatment portals and lower median tumor doses (< or = 80% of the doses delivered to curatively treated patients). Seventy-two patients were treated with curative intent, with nine of these having recurrent tumors after prior full-dose radiotherapy. The median duration of follow-up at the time of analysis was 31.5 months (range 3-115). Sites of disease and number of patients treated per disease site were as follows: paranasal sinus-31; oral cavity-20; oropharynx-12; nasopharynx-11; trachea-6; and other sites in the head and neck-4.
The 5-year actuarial local-regional tumor control rate for all patients treated with curative intent was 47%. Patients without involvement of the cavernous sinus, base of skull, or nasopharynx (51 patients) had a 5-year actuarial local-regional control rate of 59%, whereas local-regional control was significantly lower (15%) for patients with tumors involving these sites (p < 0.005). In the latter cases, normal tissue injury considerations precluded delivery of the full dose to the entire tumor. Patients with no history of prior radiotherapy (63 patients) had an actuarial local control rate of 57% at 5 years compared to 18% for those (9 patients) who had been previously irradiated with conventional photons (p = 0.018). Eliminating the dose-limiting factors of prior radiation therapy and/or high risk sites of involvement, the 5-year actuarial local-regional control rate for these 46 patients was 63%, with an actuarial cause specific survival rate of 79%. Lymph node status was a predictor of distant metastasis: 57% of node positive patients developed distant metastases by 5 years compared to 15% of patients with negative nodes (p < 0.0005), and patients who had nodal involvement developed distant metastases sooner than node negative patients (p < 0.0001). The 5-year actuarial overall survival and cause specific survival for the 72 patients treated with curative intent were 59% and 64%, respectively.
Fast neutron radiotherapy offers high local-regional control and survival rates for patients with locally advanced, unresectable adenoid cystic carcinomas of minor salivary glands. It should be considered as initial primary treatment for these patients, as well as for other patients in whom surgical extirpation would cause considerable morbidity.
研究快中子放射治疗对局部晚期小涎腺腺样囊性癌患者的疗效，并确定与局部控制、总生存率及特定病因生存率相关的预后变量。
1985年至1994年间，84例小涎腺腺样囊性癌患者接受了快中子放射治疗。所有患者均为无法切除的疾病或手术切除后仍有肉眼可见的病灶。17例患者先前接受过传统放疗，针对关键部位（脑干、脊髓、脑）对其后续快中子放疗的治疗野和剂量进行了调整。尽管中位剂量（肿瘤最大剂量和肿瘤最小剂量）仅相差≤10%，但由于正常组织并发症的考虑，这些患者的治疗野明显更小。12例患者（13%）在治疗时已有远处转移，仅接受了姑息性治疗，治疗野更小，肿瘤中位剂量更低（≤根治性治疗患者剂量的80%）。72例患者接受了根治性治疗，其中9例在先前全剂量放疗后出现复发性肿瘤。分析时的中位随访时间为31.5个月（范围3 - 115个月）。疾病部位及每个疾病部位的治疗患者数量如下：鼻窦 - 31例；口腔 - 20例；口咽 - 12例；鼻咽 - 11例；气管 - 6例；头颈部其他部位 - 4例。
所有接受根治性治疗患者的5年精算局部区域肿瘤控制率为47%。未累及海绵窦、颅底或鼻咽的患者（51例）5年精算局部区域控制率为59%，而累及这些部位的患者局部区域控制率显著较低（15%）（p < 0.005）。在后一种情况下，由于正常组织损伤的考虑，无法对整个肿瘤给予全剂量照射。无先前放疗史的患者（63例）5年精算局部控制率为57%，而先前接受过传统光子放疗的患者（9例）为18%（p = 0.018）。去除先前放疗和/或高风险受累部位的剂量限制因素后，这46例患者的5年精算局部区域控制率为63%，精算特定病因生存率为79%。淋巴结状态是远处转移的预测指标：57%的淋巴结阳性患者在5年内发生远处转移，而淋巴结阴性患者为15%（p < 0.0005），有淋巴结受累的患者比淋巴结阴性患者更早发生远处转移（p < 0.0001）。72例接受根治性治疗患者的5年精算总生存率和特定病因生存率分别为59%和64%。
快中子放射治疗为局部晚期、无法切除的小涎腺腺样囊性癌患者提供了较高的局部区域控制率和生存率。对于这些患者以及手术切除会导致相当大发病率的其他患者，应将其视为初始主要治疗方法。
