Adenoid cystic carcinoma of the salivary glands. Management of recurrent, advanced, or persistent disease with hyperthermia and radiation therapy

Abstract

Adenoid cystic carcinomas (ACC) of the salivary glands are aggressive tumors characterized by multiple late local recurrences and distant metastases. Current therapy includes wide local excision and high-dose postoperative radiation therapy (XRT) (5400 to 7000 cGy). Despite early aggressive treatment, local recurrence remains a major problem with limited safe and effective therapeutic options available. The excellent local responses obtained in four patients (six sites) with ACC of the head and neck treated either with additional low-dose irradiation (2160 to 3420 cGy) in conjunction with two to five hyperthermia (HT) treatments or with full dose XRT and HT as part of the overall treatment plan are reported. All HT treatments were for 45 minutes once steady state conditions were obtained. Monitored intratumoral temperatures for all treatments achieved average maximum (Tmax), average mean (Tave), and average minimum (Tmin) temperatures of 44.2"C, 41.2"C, and 38.9"c, respectively. A complete response was obtained for all six fields with no significant long-term complications. Two patients remain alive and free of local disease at 42 and 63 months of follow-up. Two patients died-one with metastases (with persistent local control) and one with a local recurrence at 9 and 30 months, respectively, after XRT and HT. This is the first report of HT and low-dose XRT in the management of previously irradiated ACC and suggests a potential role for the use of this modality in the treatment of ACC. Cancer 65:2648-2656,1990. __ ~ DENOID CYSTIC CARCINOMAS (ACC) of the salivary A glands are aggressive salivary gland cancers. ACC represent 7% to 18% of parotid malignan~ies,'-~ and 33% to 58% of minor salivary gland malignancies.'~~-~ Treatment has included surgery, radiation therapy (XRT), or a combination of the two. Despite aggressive local treatment , the disease is characterized by multiple, often late, local recurrences and distant metastases. Failure may

Stereotactic body radiation therapy for locally recurrent, previously irradiated nonsquamous cell cancers of the head and neck

“…25 Median overall follow-up from SBRT completion was 10 months (absolute range, 0-55 months), with a median follow-up of 12 months (absolute range, 3-55 months) for surviving patients. Follow-up imaging was available for 85% of included patients, with a median number of total restaging studies (CT, PET-CT, or MRI) of 3 (absolute range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Maximum tumor response, in accord with the modified RECIST criteria, was 19% complete response (CR), 41% partial response (PR), 22% stable disease (SD), and the remainder had progressive disease (PD).…”

“…[4][5][6] Despite aggressive multimodality treatment approaches including surgery, radiation, and chemotherapy, tumor control remains suboptimal, with recurrence rates up to 90% described for histologic entities such as adenoid cystic carcinoma. 7 Locally recurrent head and neck cancers represent a clinical challenge where surgical salvage may often be limited by technical feasibility and/or quality-of-life considerations. 8 Similarly, chemotherapy has shown poor results in terms of response and long-term ef-ficacy, and conventional techniques of reirradiation are limited by treatment delivery considerations constrained by dose tolerance limitations of normal surrounding tissue.…”

Gamma knife radiosurgery for recurrent salivary gland malignancies involving the base of skull

“…Data on this approach indicate, however, that reirradiation should be considered in many patients either as the sole treatment or as an adjuvant treatment. 5 For example, adenoid cystic carcinoma has the propensity for perineural spread to the skull base, and surgical resection often is not possible.…”