THE INFLUENCE OF POSITIVE MARGINS AND NERVE INVASION IN ADENOID CYSTIC CARCINOMA OF THE HEAD AND NECK TREATED WITH SURGERY AND RADIATION
THE INFLUENCE OF POSITIVE MARGINS AND NERVE INVASION IN ADENOID CYSTIC CARCINOMA OF THE HEAD AND NECK TREATED WITH SURGERY AND RADIATION
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DOI：
10.1016/0360-3016(95)00122-f
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发表时间：
1995-06-15
影响因子：
7
通讯作者：
PETERS, LJ
中科院分区：
文献类型：
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作者：
GARDEN, AS;WEBER, RS;PETERS, LJ
目的：手术是头颈部大、小唾液腺样囊性癌的主要治疗方法。然而，局部复发是频繁的，因为浸润性生长模式和周围神经扩散与这些肿瘤。在UTMDACC，我们有一个长期的政策，使用术后放疗，以减少局部复发的风险，并避免根治性手术的需要;这项30年的回顾性研究分析了这种综合方式的方法的结果。方法和材料：1962年至1991年，198例年龄13-82岁的头颈部腺样囊性癌患者，因术后已知或疑似显微镜下残留病变接受术后放疗。原发部位分布为：腮腺：30例患者;下颌下/舌下：41例患者;泪腺：5例患者;小唾液腺：122例患者。83例患者（42%）有显微镜下阳性切缘，另外55例（28%）有接近（小于或等于5 mm）或不确定的切缘。136名患者（69%）有神经周围扩散，其中55名患者（28%）侵犯了主要（命名）神经。使用适合于原发部位的放射技术，将60戈伊（范围50-69戈伊）的中位剂量递送至肿瘤床。随访时间范围为5-341个月（中位数，93个月）。所有存活的患者有一个最低的2年follow-up.Results：23例（12%）有局部复发与5，10，和15年的精算局部控制率分别为95%，86%和79%。83例切缘阳性患者中有15例（18%）发生局部复发，而切缘接近或不确定的55例患者中有5例（9%）发生局部复发，切缘阴性的60例患者中有3例（5%）发生局部复发（p = 0.02）。有和没有主要（命名）神经受累的患者的粗失败率分别为18%（10/55）和9%（13/143）（p = 0.02）。随着剂量的增加，局部控制有改善的趋势。这在具有阳性边缘的患者中是显著的，在这些患者中，
Purpose: Surgery is the primary treatment for adenoid cystic carcinomas arising from major and minor salivary glands of the head and neck. However, local recurrence is frequent because of the infiltrative growth pattern and perineural spread associated with these tumors. At UTMDACC, we have had a long-standing policy of using postoperative radiotherapy to reduce the risk of local recurrence and to avoid the need for radical surgery; this 30-year retrospective study analyzes the results of this combined modality approach.Methods and Materials: Between 1962 and 1991, 198 patients ages 13-82 years, with adenoid cystic carcinomas of the head and neck, received postoperative radiotherapy for known or suspected microscopic residual disease following surgery. Distribution of primary sites was: parotid: 30 patients; submandibular/sublingual: 41 patients; lacrimal: 5 patients; and minor Salivary glands: 122 patients. Eighty-three patients (42%) had microscopic positive margins and an additional 55 (28%) had close (less than or equal to 5 mm) or uncertain margins. One hundred thirty-six patients (69%) had perineural spread with invasion of a major (named) nerve in 55 patients (28%). Using radiation techniques appropriate to the primary site, a median dose of 60 Gy (range 50-69 Gy) was delivered to the tumor bed. Follow-up ranged from 5-341 months (median, 93 months). All surviving patients had a minimum of 2 years follow-up.Results: Twenty-three patients (12%) had local recurrences with 5-, 10-, and 15-year actuarial local control rates of 95%, 86%, and 79%, respectively. Fifteen of the 83 patients (18%) with positive margins developed local recurrences, compared to 5 of 55 patients (9%) with close or uncertain margins, and 3 of 60 patients (5%) with negative margins (p = 0.02). Patients with and without a major (named) nerve involved had crude failure rates of 18% (10 out of 55) and 9% (13 out of 143), respectively (p = 0.02). There was a trend toward better local control with increasing dose. This was significant in patients with positive margins, in whom crude control rates were 40 and 88% for doses of