Re-irradiation of adenoid cystic carcinoma: Analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy
Re-irradiation of adenoid cystic carcinoma: Analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy
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DOI：
10.1016/j.radonc.2015.01.002
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发表时间：
2015-02-01
影响因子：
5.7
通讯作者：
Debus, Juergen
中科院分区：
文献类型：
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作者：
Jensen, Alexandra D.;Poulakis, Melanie;Debus, Juergen
背景：先前放疗后腺样囊性癌（ACC）局部复发的治疗仍然是一个挑战：如果没有手术挽救的可能性，患者面临姑息化疗和再次放疗之间的选择。化疗的反应率约为 30%，并且由于靠近关键结构，因此很难应用杀肿瘤剂量。碳离子疗法（C12）是一种有前景的方法，可最大限度地减少该适应症的副作用并最大限度地提高再治疗剂量。我们描述了对接受过大量治疗的 ACC 患者进行再次照射的初步结果。方法：对 2010 年 4 月至 2013 年 5 月期间接受碳离子治疗的患者（N = 52 例，中位年龄：54 岁）进行了毒性 (NCI CTC v.4)、肿瘤反应 (RECIST) 和控制率的回顾性评估。 48 名患者 (92.3%) 仅接受碳离子治疗，4 名患者接受 IMRT 加 C12。结果：4 名患者在 R1 切除后接受治疗，43 名患者因无法手术的局部复发而接受治疗。最常见的肿瘤部位是鼻窦（36.5%）、腮腺（19.2%）和颅底（17.3%）。中位 RT 间隔 61 个月后，患者接受的中位剂量为 51 GyE C12/63 Gy BED，累积剂量为 128 Gy BED [67-182 Gy]。中位目标体积为 93 ml [9-618 ml]。未观察到更高级（>II度）急性反应，7例出现血脑屏障改变（I/II度：8例；III度：2例），角膜溃疡1例，干眼症7例，IV度出血1例，组织坏死2例，其他无明显晚期反应。客观缓解率（CR/PR）为56.6%。中位随访时间为 14 个月 [1-39 个月]，la 的局部控制和远程控制分别为 70.3% 和 72.6%。在 18 例局部复发的患者中，13 例在视野内复发，1 例在视野边缘，3 例在视野外，1 例在剂量梯度中。结论：尽管应用剂量较高，C12 再次照射显示出中等副作用，即使在这些经过大量治疗的患者中，反应率也令人鼓舞，并且是姑息化疗的良好替代方案。尽管大多数局部复发发生在高剂量区域，但应谨慎对待剂量的进一步增加。 (C) 2015 年作者。由爱思唯尔爱尔兰有限公司出版
Background: Treatment of local relapse in adenoid cystic carcinoma (ACC) following prior radiation remains a challenge: without the possibility of surgical salvage patients face the choice between palliative chemotherapy and re-irradiation. Chemotherapy yields response rates around 30% and application of tumouricidal doses is difficult due to proximity of critical structures. Carbon ion therapy (C12) is a promising method to minimize side-effects and maximize re-treatment dose in this indication. We describe our initial results for re-irradiation in heavily pre-treated ACC patients.Methods: Patients treated with carbon ion therapy between 04/2010 and 05/2013 (N= 52 pts, median age: 54 a) were retrospectively evaluated regarding toxicity (NCI CTC v.4), tumour response (RECIST) and control rates. 48 pts (92.3%) received carbon ions only, 4 pts received IMRT plus C12.Results: 4 pts were treated following R1-resection, 43 pts for inoperable local relapse. Most common tumour sites were paranasal sinus (36.5%), parotid (19.2%), and base of skull (17.3%). Pts received a median dose of 51 GyE C12/63 Gy BED and cumulative dose of 128 Gy BED [67-182 Gy] after a median RT-interval of 61 months. Median target volume was 93 ml [9-618 ml]. No higher-grade (>degrees II) acute reactions were observed, 7 pts showed blood-brain-barrier changes (degrees I/II: 8 pts; degrees III: 2 pts), 1 pt corneal ulceration, xerophthalmia 7 pts, degrees IV bleeding 1 pt, tissue necrosis 2 pts, otherwise no significant late reactions. Objective response rate (CR/PR) was 56.6%. With a median follow-up of 14 months [1-39 months] local control and distant control at la are 70.3% and 72.6% respectively. Of the 18 pts with local relapse, 13 pts have recurred in-field, 1 pt at the field edge, 3 pts out of field, and one in the dose gradient.Conclusion: Despite high applied doses, C12 re-irradiation shows moderate side-effects, response rates even in these heavily pre-treated patients are encouraging and present a good alternative to palliative chemotherapy. Though most local recurrences occur within the high-dose area, further dose escalation should be viewed with caution. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.