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Romanò R, De Felice F, Ferri A, Della Monaca M, Maroldi R, Licitra L, Locati LD, Alfieri S. Adenoid Cystic carcinoma of minor salivary glands (AdCCmSG): a multidisciplinary update. Expert Rev Anticancer Ther 2024; 24:567-580. [PMID: 38832770 DOI: 10.1080/14737140.2024.2357806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Adenoid cystic carcinoma of minor salivary glands (AdCCmSG) represents a 'rarity in the rarity,' posing a clinical challenge in lack of standardized, evidence-based recommendations. At present, AdCCmSG management is mostly translated from major salivary gland cancers (MSGCs). Ideally, AdCCmSG diagnostic-therapeutic workup should be discussed and carried out within a multidisciplinary, high-expertise setting, including pathologists, surgeons, radiation oncologists and medical oncologists. AREAS COVERED The present review provides an overview of epidemiology and pathologic classification. Moreover, the most recent, clinically relevant updates in the treatment of AdCCmSG (Pubmed searches, specific guidelines) are critically discussed, aiming to a better understanding of this rare pathologic entity, potentially optimizing the care process, and offering a starting point for reflection on future therapeutic developments. EXPERT OPINION The management of rare cancers is often hindered by limited data and clinical trials, lack of evidence-based guidelines, and hardly represented disease heterogeneity, which cannot be successfully tackled with a 'one-size-fits-all' approach. Our goal is to address these potential pitfalls, providing an easy-to-use, updated, multidisciplinary collection of expert opinions concerning AdCCmSG management as of today's clinical practice. We will also cover the most promising future perspectives, based on the potential therapeutic targets highlighted within AdCCmSG's molecular background.
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Affiliation(s)
- Rebecca Romanò
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Rome, Italy
| | - Roberto Maroldi
- Division of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milan, Milan, Italy
| | - Laura Deborah Locati
- Translational Oncology Unit, Istituto di Ricerca e Cura a carattere scientifico (IRCCS) Istituti Clinici Scientifici (ICS) Maugeri, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Augustin E, Holtzman AL, Dagan R, Bryant CM, Indelicato DJ, Morris CG, Deraniyagala RL, Fernandes RP, Bunnell AM, Nedrud SM, Mendenhall WM. Long-Term Outcomes Following Definitive or Adjuvant Proton Radiotherapy for Adenoid Cystic Carcinoma. Int J Part Ther 2024; 11:100008. [PMID: 38757074 PMCID: PMC11096740 DOI: 10.1016/j.ijpt.2024.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose Adenoid cystic carcinoma (ACC) is a rare malignancy accounting for 1% of all head and neck cancers. Treatment for ACC has its challenges and risks, yet few outcomes studies exist. We present long-term outcomes of patients with ACC of the head and neck treated with proton therapy (PT). Materials and Methods Under an institutional review board-approved, single-institutional prospective outcomes registry, we reviewed the records of 56 patients with de novo, nonmetastatic ACC of the head and neck treated with PT with definitive (n = 9) or adjuvant PT (n = 47) from June 2007 to December 2021. The median dose to the primary site was 72.6 gray relative biological equivalent (range, 64-74.4) delivered as either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received concurrent chemotherapy. Thirty-one patients received nodal radiation, 30 electively and 1 for nodal involvement. Results With a median follow-up of 6.2 years (range, 0.9-14.7), the 5-year local-regional control (LRC), disease-free survival, cause-specific survival, and overall survival rates were 88%, 85%, 89%, and 89%, respectively. Intracranial extension (P = .003) and gross residual tumor (P = .0388) were factors associated with LRC rates. While the LRC rate for those with a gross total resection was 96%, those with subtotal resection or biopsy alone were 81% and 76%, respectively. The 5-year cumulative incidence of clinically significant grade ≥3 toxicity was 15%, and the crude incidence at the most recent follow-up was 23% (n = 13). Conclusion This is the largest sample size with the longest median follow-up to date of patients with ACC treated with PT. PT can provide excellent disease control for ACC of the head and neck with acceptable toxicity. T4 disease, intracranial involvement, and gross residual disease at the time of PT following either biopsy or subtotal resection were significant prognostic features for worse outcomes.
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Affiliation(s)
- Etzer Augustin
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Adam L. Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Curtis M. Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Daniel J. Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Rohan L. Deraniyagala
- Department of Radiation Oncology, Corewell Health/Beaumont Hospital, Royal Oak, Michigan, USA
| | - Rui P. Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Anthony M. Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Stacey M. Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
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Choi SG. Adenoid cystic carcinoma of distal trachea: A case report. Clin Case Rep 2024; 12:e8495. [PMID: 38371343 PMCID: PMC10874474 DOI: 10.1002/ccr3.8495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Key Clinical Message This case report highlights the rarity of distal tracheal adenoid cystic carcinoma and emphasizes the importance of considering it as a differential diagnosis in patients presenting with sustained dyspnea. Early diagnosis and a multidisciplinary approach involving thoracic surgeons, radiation oncologists, and medical oncologists are crucial for optimal treatment planning and patient outcomes. Further research is warranted to better understand the pathogenesis, molecular characteristics, and optimal management strategies for this rare tracheal malignancy. Abstract Adenoid cystic carcinoma (ACC) is an unusual malignant neoplasm that mostly arises in the minor salivary glands. It can also occur in various mucous membrane-lined structures, including the trachea. The treatment of choice is surgery in resectable cases, but radiotherapy and chemotherapy are generally utilized for unresectable cases or palliative treatment. In this study, I report my experience with a case of unresectable ACC occurring in a distal trachea treated with concurrent chemoradiotherapy (CCRT), based on the patient's clinical presentation, diagnostic workup, histopathological findings, treatment modalities, and long-term prognosis.
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Affiliation(s)
- Sang Gyu Choi
- Department of Radiation OncologyDankook University Hospital, Dankook University School of MedicineCheonanChungcheognamdoKorea
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Hong S, Garces YI, Price KA, Shinya Y, Parney IF, Link MJ, Pollock BE. Treatment outcomes of single-fraction stereotactic radiosurgery for adenoid cystic carcinoma: a case series of 55 patients. J Neurooncol 2024; 166:369-376. [PMID: 38180687 DOI: 10.1007/s11060-024-04561-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/06/2024]
Abstract
PURPOSE This study aimed to analyze the treatment outcomes of single-fraction stereotactic radiosurgery (SRS) for adenoid cystic carcinoma patients. METHODS Retrospective analysis was conducted for 55 patients with 66 lesions. SRS intentions were categorized as definitive, adjuvant, salvage, and palliative. Tumor control was defined as local (within 50% isodose line), marginal (outside 50% isodose line), and distant (metastasis outside head/neck). RESULTS The median age was 60 years (range 21-85), with 53% males. Tumor origin was head/neck for 88% and trachea/lung for 12%. 61% were recurrent lesions. Median interval from diagnosis to SRS was 14 months. Preceding surgery was performed in 30%. SRS was administered as definitive (30 lesions), adjuvant (13), salvage (19), and palliative (4). SRS was used as a boost to external beam radiation therapy (EBRT) in 39%. Concurrent chemotherapy was administered in 26%. 5-, 10-, and 15-year local control rates were 60%, 33%, and 27%, respectively; local/marginal control rates were 29%, 13%, and 10%. For recurrent lesions treated with SRS without EBRT, 5-year local control rate was 14%, and local/marginal control rate was 5%. For recurrent lesions treated with SRS and EBRT, 5-year local control rate was 100%, and local/marginal control rate was 40%. The rate of distant failure after SRS was 40%. Older age and distant metastasis before SRS were negative factors for overall survival. CONCLUSION SRS provided a high rate of local tumor control, but marginal failure was frequent. Integrating SRS with added EBRT exhibits potential for enhancing local and local/marginal tumor control, particularly in recurrent cases.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, 55905, Rochester, Minnesota, USA
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuki Shinya
- Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, 55905, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, 55905, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, 55905, Rochester, Minnesota, USA
| | - Bruce E Pollock
- Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, 55905, Rochester, Minnesota, USA.
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Nakamura M, Ohnishi K, Nakazawa K, Shimizu K, Miyauchi D, Mizumoto M, Nakai K, Okumura T, Sakurai H. Long-term follow-up of unresectable adenoid cystic carcinoma of the trachea and bronchus treated with high-dose proton beam therapy: A report of two cases. Thorac Cancer 2024; 15:201-205. [PMID: 37984929 PMCID: PMC10788470 DOI: 10.1111/1759-7714.15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of the trachea is a rare disease that is slow growing and has a risk of distant metastasis. The standard treatment for ACC of the trachea is surgery, but this tumor is often unresectable. In definitive radiotherapy using photons for unresectable ACC of the trachea, it is sometimes difficult to deliver a sufficient dose to the target without exceeding the tolerable dose to the surrounding normal tissues. Here, we report two cases of ACC of the trachea that received a high dose (74 Gy [relative biological effectiveness]) of proton beam therapy and achieved long-term survival.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
- Department of Radiology, School of MedicineInternational University of Health and WelfareChibaJapan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kei Shimizu
- Department of Respiratory MedicineHitachi General HospitalIbarakiJapan
| | - Daigo Miyauchi
- Department of Health ScreeningSakuragawa Regional Medical CenterIbarakiJapan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kei Nakai
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
- Department of Radiation OncologyIbaraki Prefectural Central HospitalIbarakiJapan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
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Hsieh RCE, Chou YC, Hung CY, Lee LY, Venkatesulu BP, Huang SF, Liao CT, Cheng NM, Wang HM, Wu CE, Kang CJ, Chen MF, Cheng YF, Yeh KY, Wang CH, Chou WC, Lin CY. A multicenter retrospective analysis of patients with salivary gland carcinoma treated with postoperative radiotherapy alone or chemoradiotherapy. Radiother Oncol 2023; 188:109891. [PMID: 37659659 DOI: 10.1016/j.radonc.2023.109891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The aim of this study was to interrogate if the use of postoperative chemoradiotherapy (POCRT) correlated with superior oncological outcomes for certain subgroups of patients with high-risk salivary gland carcinoma (SGC), compared with postoperative radiotherapy (PORT) alone. METHODS This multicenter retrospective study included 411 patients with surgically resected SGC who underwent PORT (n = 263) or POCRT (n = 148) between 2000 and 2015. Possible correlations of clinical parameters with outcomes were examined using the Kaplan-Meier analysis and Cox proportional-hazards regression model. RESULTS The median follow-up of survivors is 10.9 years. For the entire cohort, adding concurrent chemotherapy to PORT was not associated with OS, PFS, or LRC improvement. However, patients with nodal metastasis who underwent POCRT had significantly higher 10-year OS (46.2% vs. 18.2%, P = 0.009) and PFS (38.7% vs. 10.0%, P = 0.009) rates than those treated with PORT alone. The presence of postoperative macroscopic residual tumor (R2 resection) was identified as an independent prognosticator for inferior OS (P = 0.032), PFS (P = 0.001), and LRC (P = 0.007). Importantly, POCRT significantly correlated with higher 10-year LRC rates in patients with R2 resection (74.2% vs. 40.7%, P = 0.034) or adenoid cystic carcinoma (AdCC, 97.6% vs. 83.6%, P = 0.039). On multivariate analyses, the use of POCRT significantly predicted superior OS (P = 0.037) and PFS (P = 0.013) for node-positive patients and LRC for patients with R2 resection (P = 0.041) or AdCC (P = 0.005). CONCLUSIONS For surgically resected SGC, POCRT was associated with improved long-term OS and PFS for patients with nodal metastasis and superior LRC for patients with R2 resection or AdCC.
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Affiliation(s)
- Rodney Cheng-En Hsieh
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chia-Yen Hung
- Department of Hema-oncology, Division on Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Bhanu Prasad Venkatesulu
- Department of Radiation Oncology, Loyola University, Chicago, IL, USA; Edward Hines Veteran Affairs Hospital, Chicago, IL, USA
| | - Shiang-Fu Huang
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Chiao-En Wu
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | - Yu-Fan Cheng
- Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Taiwan
| | - Kun-Yun Yeh
- Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Taiwan
| | - Cheng-Hsu Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Taiwan
| | - Wen-Chi Chou
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Research Core Laboratory, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
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Mikami E, Nakamichi S, Nagano A, Misawa K, Hayashi A, Tozuka T, Takano N, Noro R, Maebayashi K, Kubokura H, Terasaki Y, Kubota K, Seike M. Successful Treatment with Definitive Concurrent Chemoradiotherapy Followed by Durvalumab Maintenance Therapy in a Patient with Tracheal Adenoid Cystic Carcinoma. Intern Med 2023; 62:2731-2735. [PMID: 36642523 PMCID: PMC10569923 DOI: 10.2169/internalmedicine.1142-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare type of malignant tracheal tumor originating from the secretory glands. Complete surgical resection is the current standard of care for tracheal ACC. However, there have been few case reports of chemoradiotherapy for unresectable tracheal ACC. We herein report a 28-year-old man with unresectable tracheal ACC who received concurrent chemoradiotherapy (CCRT) followed by maintenance therapy with durvalumab. CCRT was completed with a good response and safety, and the patient is currently receiving durvalumab as maintenance therapy. Durvalumab after CCRT can be a treatment option for patients with unresectable tracheal ACC.
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Affiliation(s)
- Erika Mikami
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Atsuhiro Nagano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazuhito Misawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Anna Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Natsuki Takano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Katsuya Maebayashi
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Hirotoshi Kubokura
- Department of Thoracic Surgery, Graduate School of Medicine, Nippon Medical School Musashikosugi Hospital, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
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Saleh E, Ukwas A. Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Review and an Assessment of the Current Management, Surgery, Radiotherapy, and Chemotherapy. Int J Otolaryngol 2023; 2023:7401458. [PMID: 37159817 PMCID: PMC10163974 DOI: 10.1155/2023/7401458] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 05/11/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare cancer that arises from the salivary glands and other sites in the body, such as the lung and breast. Although the tumor accounts for 10% of all salivary gland malignancies, it only accounts for 1% of head and neck malignancies. It can affect both major and minor salivary glands; here, it is called salivary gland adenoid cystic carcinoma or SACC, with a slight predilection to the latter, and commonly manifests between the 6th and 7th decades of life. The disease also shows a slight female predilection, with a reported female to male ratio of 3 : 2. Lesions of SACC are often insidious and slow-growing, and symptoms such as pain and altered sensation are frequently associated with advanced stages of the disease. Salivary adenoid cystic carcinoma is characterized by perineural invasion (PNI), a distinctive feature that potentially plays a significant role in the tumor's relapse and recurrence, which is approximately 50%. The disease is not prevalent, and its etiopathogenesis is poorly understood, although several genetic patterns and biomarkers have been linked to its initiation and/or progression. The discovery of these mutations and biomarkers has encouraged several clinical studies to use therapeutic agents to target the specific receptors on the cancer cells to potentially prevent further proliferation of the tumor cells and metastasis of the disease. Diagnosis of SACC is often challenging and frequently requires a combination of clinical examination, imaging, and histopathology. Management of SACC is primarily surgical excision, while radiotherapy has shown to be effective in improving local control in cases with microscopic residual disease. However, treatment of recurrent or metastatic tumors by radiotherapy with or without chemotherapy has so far shown limited success. The aim of this thesis is to provide an update of literature on SACC with a particular focus on the latest management approaches and future trends.
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Affiliation(s)
- Eyad Saleh
- Eastman Dental Institute, University College London, London, UK
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Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck. Cancers (Basel) 2021; 13:cancers13246335. [PMID: 34944955 PMCID: PMC8699151 DOI: 10.3390/cancers13246335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Adenoid cystic carcinoma is a rare histology arising in the head and neck region that has a high propensity for perineural invasion. While surgical resection is the preferred primary treatment modality, adjuvant radiotherapy is often indicated to improve local control. For unresectable disease, definitive radiotherapy can be utilized. Given the predilection for perineural tumor spread, target volumes often must encompass relevant nerve pathways back to the base of skull. Treatment strategies for ACC must therefore balance the disease burden and risk of failure against the morbidity of treatment. Abstract Adenoid cystic carcinoma of the head and neck is an uncommon malignancy that can arise in the major or minor salivary glands. Perineural invasion (PNI) is an extremely frequent finding in cases of adenoid cystic carcinoma (ACC) that can be associated with significant patient morbidity and poor prognosis. By contrast, ACC rarely demonstrates lymphovascular space invasion thereby making PNI the major avenue for metastasis and a driver of treatment rationale and design. Radiotherapy is often utilized post-operatively to improve locoregional control or as a primary therapy in unresectable disease. Here we aim to review the role of radiotherapy in the management of this malignancy with a focus on target delineation and treatment regimens in the definitive, recurrent, and metastatic settings.
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Abstract
Salivary gland carcinomas are a rare and heterogenous group of cancers with varying underlying biology and clinical behavior. A quickly evolving body of data has advanced the understanding of these tumors, leading to effective therapeutics for several histologic subtypes. Biologically rational clinical trials have developed from an understanding of MYB and NOTCH signaling in adenoid cystic carcinoma. The recognition of androgen receptor signaling and HER2-targeted therapy has offered therapeutic options in non-ACC salivary cancers. The use of TRK inhibitors in salivary secretory carcinoma has led to exceptional responses. Immunotherapy is an exciting new therapeutic avenue that requires further exploration.
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Affiliation(s)
- Vatche Tchekmedyian
- Tufts University School of Medicine, MaineHealth Cancer Care, 265 Western Avenue, Suite 2, South Portland, ME 04106, USA.
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11
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Swain M, Ghosh-Laskar S, Budrukkar A, Patil R, Murthy V, Gupta T, Mummudi N, Prabhash K, Joshi A, Patil VM, Naronha V, Agarwal JP. Concurrent chemoradiotherapy for locally advanced unresectable adenoid cystic carcinoma of head and neck: experience from a single institute. Eur Arch Otorhinolaryngol 2021; 278:4423-4431. [PMID: 33564909 DOI: 10.1007/s00405-021-06654-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the outcome of locally advanced unresectable adenoid cystic carcinoma (ACC) of head and neck treated with radical concurrent chemoradiotherapy (CRT) at a single tertiary care centre. METHODS Between 2011 and 2018, 23 patients with locally advanced unresectable ACC of head and neck treated with non-surgical radical treatment with concurrent chemoradiotherapy were evaluated for outcome and toxicity. All but one patient received cisplatin-based concurrent chemotherapy and 74% of patients were treated with intensity-modulated radiotherapy. RESULTS Median follow-up was 53 months (range 3-115 months). Following treatment, 11 patients achieved complete response (47.8%) and of the 12 patients with residual disease, 7 patients additionally had disease stabilization without local progression. Overall 15 patients had disease progression. Median time to progression was 28 months (range 6-67 months). The 3-year and 5-year overall survival, local progression-free survival (LPFS) and distant progression-free survival (DPFS) were 78%, 79.7%, 67.4% and 63%, 50.9%, 48.6%, respectively. Acute grade 3 mucositis was observed in three patients, and one patient additionally developed grade 4 neutropenia with subsequent complete recovery. No grade 3 or higher late toxicity was observed. CONCLUSION Radical concurrent chemoradiotherapy is a promising treatment option in locally advanced unresectable ACC with acceptable toxicity.
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Affiliation(s)
- Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India.
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Roshan Patil
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education for Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education for Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Naronha
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
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