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Postoperative Radiotherapy with or without Concurrent Chemotherapy for Salivary Gland Carcinomas

手術後單純放射線治療與同步放化療對唾液腺癌之長期預後比較

摘要


目的:探討同步化學治療於唾液腺癌病患手術後放射線治療之角色。材料與方法:此篇回溯性研究收納於2001年至2011年間於本院接受治療之167位唾液腺癌病患。所有入案病患皆接受根治性手術與術後放射線治療,其中共74位病患接受手術後同步放化療。兩組病患之放療中位數照射劑量均為66 Gy,而鉑金類化療藥為最常使用之同步化療藥物。結果:研究追蹤時間中位數為5.4年,接受同步放化療之病患有較多病理風險因子與較嚴重之癌症期別,然而無論針對早期或晚期病患兩組之局部腫瘤控制率、無疾病存活率與總存活率皆無統計上之顯著差異;此外,對於腺樣囊狀癌之病患,接受術後同步放化療病患之五年局部腫瘤控制率為100%,較術後單純放療病患(81%)有統計上改善之趨勢(P=.057)。在次族群分析中,對於腺樣囊狀癌合併手術邊緣陽性(P=.022)或沿神經侵犯(P=.043)之病患,術後同步放化療顯著提升局部腫瘤控制率。在整組研究族群中,主要的腫瘤復發形式為遠端轉移。結論:術後放療中施予同步化療可能可改善腺樣囊狀癌病患合併手術邊緣陽性或沿神經侵犯之局部腫瘤控制率。在多方介入治療下遠端轉移仍是唾液腺癌治療上之最大障礙。

並列摘要


Purpose: To investigate the potential value of concurrent chemotherapy in patients with salivary gland carcinomas treated with postoperative radiotherapy (PORT). Materials and Methods: This retrospective review included 167 consecutive patients with major and minor salivary gland carcinomas from 2001 to 2011. All were treated with curative surgery followed by PORT (n=93) or postoperative chemoradiotherapy (POCRT) (n=74). The median cumulative radiation doses were 66 Gy for both groups, and cisplatin-based concurrent chemotherapies were the most commonly used regimens. Results: The median follow-up was 5.4 years for survivors. Although patients receiving POCRT possessed more adverse pathological prognosticators and higher cancer stages, there were no statistical differences in locoregional control (LRC), diseasefree survival (DFS), and overall survival (OS) between the PORT and POCRT groups according to early or advanced stage. However, a trend towards LRC improvement was observed in patients with adenoid cystic carcinoma (ACC) undergoing POCRT, with 100% 5-year LRC compared with 81% for those treated with PORT (P=.057). In subgroup analyses, POCRT provided significant LRC advantages over PORT for ACC patients who also exhibited positive surgical margins (P=.022) or perineural invasion (P=.043). The predominant pattern of failure for the entire cohort was distant metastasis. Conclusions: Adding concurrent chemotherapy to postoperative radiotherapy might be most beneficial in terms of LRC for salivary gland ACC patients with positive surgical margins or perineural invasion. Distant metastasis remains problematic despite multimodal intervention.

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