Low recurrence of lung adenoid cystic carcinoma with radiotherapy and resection

Abstract

Background: Adenoid cystic carcinoma is a rare cause of thoracic malignancy, and the prognosis may depend on the extent of surgical resection and adjuvant radiotherapy. Complete resection has low rates of local recurrence but is complicated by the involvement of central airways. Adjuvant radiotherapy is frequently recommended but unproven. Methods: We describe the technicalities of radical resection and adjuvant radiotherapy using the primary endpoint of local recurrence and secondary endpoints of locoregional (mediastinal) recurrence and distant metastasis. Resections were classed as microscopically and macroscopically clear (R0) or only macroscopically clear (R1). Results: Twelve patients (eight males) diagnosed between 1999 and 2016, with an average age of 44 AE 12 years, were included. Six of these were operable (operative group), and six had non-resectable lesions (radiotherapy group). In the operative group, three had tracheal disease and three had bronchial disease. Tracheal lesions underwent excision with tracheal anastomosis (all R1 resections). Main bronchial lesions underwent complete excision via pneumonectomy (two R0 and one R1 resections). All these patients received 50-60 Gray of adjuvant radiotherapy. At an average follow-up of 6.1 AE 4.3 years, no patient had local recurrence, two had locoregional recurrence and four had distant metastasis. The radiotherapy group received 60-70 Gray as definitive therapy, and at an average follow-up of 5.4 AE 4.2 years, three had locoregional recurrence and four had distant metastasis. Conclusion: Our case series consolidates evidence that early radical resection and radiotherapy is associated with a low risk of local recurrence in patients with thoracic adenoid cystic carcinoma.

Synchrotron Microbeam Radiation Therapy for the Treatment of Lung Carcinoma: A Preclinical Study

“…Given its superior tumour control and observed sparing of the normal lung, S-MRT could be a novel alternative for treating lung tumours, including central and ultra-central malignancies and cases where complete tumour resection is not possible. 22 Here we show, for the first time, the successful application of S-MRT in a new pre-clinical mouse model of lung carcinoma. Tumour-bearing lungs were irradiated with either two cross-fired arrays of S-MRT or Synchrotron-Broad Beam (S-BB) radiation, with a control group receiving no treatment.…”

A population study comparing tracheal and lung adenoid cystic carcinoma

“…In addition, surgery for safer anastomotic tension tends to result in higher rate of positive margins 15,18 . Although some case series showed that surgical resection with negative margins was an important prognostic factor, R1 resection followed by radiotherapy resulted in comparable long‐term survival to TACC patients with R0 resection 11,19–22 . For LACC patients, fewer receive local treatment compared to TACC, which may be related to the more aggressive biological behavior and later staging of LACC.…”

“… 15 , 18 Although some case series showed that surgical resection with negative margins was an important prognostic factor, R1 resection followed by radiotherapy resulted in comparable long‐term survival to TACC patients with R0 resection. 11 , 19 , 20 , 21 , 22 For LACC patients, fewer receive local treatment compared to TACC, which may be related to the more aggressive biological behavior and later staging of LACC. Among local treatment options, only radiotherapy is less important, while surgery plays a more significant role.…”

Multiple primary lung cancer comprised of adenocarcinoma and adenoid cystic carcinoma: a case report

“…A rare type of tumor, ACC of the lung accounts for 0.04-0.2% of primary pulmonary tumors (7). It commonly involves the salivary glands in the head and neck (8). Histologically, ACC exhibits 3 main growth patterns: the cribriform, tubular, and solid patterns.…”