- 作者：Jonathan D. Schoenfeld ; M.D.&lowast ; ; jdschoenfeld@partners.org ; David J. Sher ; M.D. ; M.P.H.&dagger ; ; Charles M. Norris Jr. ; M.D.&Dagger ; ; Robert I. Haddad ; M.D.§ ; ; ¶ ; ; Marshall R. Posner ; M.D.§ ; ; ¶ ; ; Tracy A. Balboni ; M.D. ; M.P.H.&dagger ; ; Roy B. Tishler ; M.D. ; Ph.D.&dagger ;
- 关键词：Chemoradiotherapy ; Salivary gland cancers ; Intensity-modulated radiotherapy ; Adenoid cystic carcinoma ; Mucoepidermoid carcinoma
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 January 2012
- 年：2012
- 卷：82
- 期：1
- 页码：308-314
- 全文大小：472 K
Purpose
To analyze the recent single-institution experience of patients with salivary gland tumors who had undergone adjuvant intensity-modulated radiotherapy (IMRT), with or without concurrent chemotherapy.Patients and Methods
We performed a retrospective analysis of 35 salivary gland carcinoma patients treated primarily at the Dana-Farber Cancer Institute between 2005 and 2010 with surgery and adjuvant IMRT. The primary endpoints were local control, progression-free survival, and overall survival. The secondary endpoints were acute and chronic toxicity. The median follow-up was 2.3 years (interquartile range, 1.2?.8) among the surviving patients.
Results
The histologic types included adenoid cystic carcinoma in 15 (43 % ), mucoepidermoid carcinoma in 6 (17 % ), adenocarcinoma in 3 (9 % ), acinic cell carcinoma in 3 (9 % ), and other in 8 (23 % ). The primary sites were the parotid gland in 17 (49 % ), submandibular glands in 6 (17 % ), tongue in 4 (11 % ), palate in 4 (11 % ), and other in 4 (11 % ). The median radiation dose was 66 Gy, and 22 patients (63 % ) received CRT. The most common chemotherapy regimen was carboplatin and paclitaxel (n = 14, 64 % ). A trend was seen for patients undergoing CRT to have more adverse prognostic factors, including Stage T3-T4 disease (CRT, n = 12, 55 % vs. n = 4, 31 % , p = .29), nodal positivity (CRT, n = 8, 36 % vs. n = 1, 8 % , p = .10), and positive margins (n = 13, 59 % vs. n = 5, 38 % , p = .30). One patient who had undergone CRT developed an in-field recurrence, resulting in an overall actuarial 3-year local control rate of 92 % . Five patients (14 % ) developed distant metastases (1 who had undergone IMRT only and 4 who had undergone CRT). Acute Grade 3 mucositis, esophagitis, and dermatitis occurred in 8 % , 8 % , and 8 % (1 each) of IMRT patients and in 18 % , 5 % , and 14 % (4, 1, and 3 patients) of the CRT group, respectively. No acute Grade 4 toxicity occurred. The most common late toxicity was Grade 1 xerostomia (n = 8, 23 % ).
Conclusions
Treatment of salivary gland malignancies with postoperative IMRT was well tolerated with a high rate of local control. Chemoradiotherapy resulted in excellent local control in a subgroup of patients with adverse prognostic factors and might be warranted in select patients.