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Titre du document / Document title

Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy

Auteur(s) / Author(s)

DOUGLAS J. G. (1 2) ; LARAMORE G. E. (1) ; AUSTIN-SEYMOUR M. (1) ; KOH W.-J. (1) ; STELZER K. (1) ; GRIFFIN T. W. (2) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, ETATS-UNIS
(2) Department of Pediatrics, University of Washington Affiliated Hospitals, Children's Hospital and Regional Medical Center, Seattle, WA, ETATS-UNIS

Résumé / Abstract

Purpose: To examine the efficacy of fast neutron radiotherapy for the treatment of locally advanced and/or recurrent adenoid cystic carcinoma of the head and neck and to identify prognostic variables associated with local-regional control and survival. Methods and Materials: One hundred fifty-nine patients with nonmetastatic, previously unirradiated, locally advanced, and/or recurrent adenoid cystic carcinoma (ACC) of the head and neck region were treated with fast neutron radiotherapy during the years 1985-1997. One hundred fifty-one patients had either unresectable disease, or gross residual disease (GRD) after an attempted surgical extirpation. Eight patients had microscopic residual disease and were analyzed separately. Sixty-two percent of patients had tumors arising in minor salivary glands, 29% in major salivary glands, and 9% in other sites such as the lacrimal glands, tracheal-bronchial tree, etc. Fifty-five percent of patients were treated for postsurgical recurrent disease and 13% of patients had lymph node involvement at the time of treatment. The median duration of follow-up was 32 months (range 3-142 months). Actuarial curves for survival, cause-specific survival, local-regional control, and the development of distant metastases are presented for times out to 11 years. Results: The 5-year actuarial local-regional tumor control rate for the 151 patients with GRD was 57%; the 5-year actuarial overall survival rate was 72%; and the 5-year actuarial cause-specific survival rate was 77%. Variables associated with decreased local-regional control in the patients with GRD as determined by multivariate analysis included base of skull involvement (p < 0.01) and biopsy only versus an attempted surgical resection prior to treatment (p = 0.03). Patients without these negative factors had an actuarial local-regional control rate of 80% at 5 years. Patients with microscopic residual disease (n = 8) had a 5-year actuarial local-regional control rate of 100%. Base of skull involvement (p < 0.001), lymph node metastases at the time of treatment (p < 0.01), biopsy only prior to neutron radiotherapy (p = 0.03), and recurrent tumors (p = 0.04) were found to be associated with a diminished cause-specific survival as ascertained by multivariate analysis. Patients with base of skull involvement and positive lymph nodes at presentation had an increased rate of the development of distant metastases at 5 years, (p < 0.01 and p <0.001, respectively). No statistical difference in outcome was observed between major and minor salivary gland sites. Conclusions: Fast neutron radiotherapy is an effective treatment for locally advanced ACC of the head and neck region with acceptable toxicity. Further improvements in local-regional control are not likely to impact survival until more effective systemic agents are developed to prevent and/or treat distant metastatic disease.

Revue / Journal Title

International journal of radiation oncology, biology, physics    ISSN  0360-3016   CODEN IOBPD3 

Source / Source

Congrès
International Conference on Translational Research and Pre-Clinical Strategies in Clinical Radio-Oncology ICTR 2000 No1, Lugano , SUISSE (05/03/2000)
2000, vol. 46, no 3, pp. 687-795 (29 ref.), pp. 551-557

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1975) (Revue)

Mots-clés anglais / English Keywords

Malignant tumor

;

Head and neck

;

Human

;

Adenoid cystic carcinoma

;

Advanced stage

;

Focal lesion

;

Neutron beam

;

Radiotherapy

;

Treatment planning

;

Treatment efficiency

;

Prognosis

;

Salivary gland

;

ENT disease

;

Stomatology

;

Salivary gland disease

;

Mots-clés français / French Keywords

Tumeur maligne

;

Tête cou

;

Homme

;

Adénocarcinome kystique

;

Stade avancé

;

Lésion focale

;

Faisceau neutron

;

Radiothérapie

;

Plan traitement

;

Efficacité traitement

;

Pronostic

;

Glande salivaire

;

ORL pathologie

;

Stomatologie

;

Glande salivaire pathologie

;

Mots-clés espagnols / Spanish Keywords

Tumor maligno

;

Cabeza cuello

;

Hombre

;

Adenocarcinoma quístico

;

Estadio avanzado

;

Lesión focal

;

Haz neutrónico

;

Radioterapia

;

Plan tratamiento

;

Eficacia tratamiento

;

Pronóstico

;

Glándula salival

;

ORL patología

;

Estomatología

;

Glándula salival patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 17180, 35400008629538.0050

Nº notice refdoc (ud4) : 1277395



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