M.W. Huang

Factors influencing survival rate in adenoid cystic carcinoma of the salivary glands

OBJECTIVEnTo study factors influencing survival rate of adenoid cystic carcinoma (ACC) of the salivary glands.nnnMETHODSnOne hundred and twelve cases were followed up for move than ten years and were studied to investigate factors influencing the survival rate of patients. Statistical analysis was performed using a computer program (Survcalc, John Wiley Co.). The data were statistically treated for survival curves according to the kaplan-meier method. The log rank tests were employed to assess the statistical significance of various groups.nnnRESULTSnThe age of the patients younger than 50 years old, early clinical stage, glandular/tubular histological type and tumor without nerve involvement had the best prognosis. Age of the patients older than 50 years old, ACC in the submandibular gland, advanced clinical stage (stage III and IV), solid histological type and tumor with nerve involvement had a poor prognosis.nnnCONCLUSIONSnAge of the patients, tumour site, clinical stage, histological type and with or without nerve involvement are the important factors influencing the prognosis.

125I brachytherapy alone for recurrent or locally advanced adenoid cystic carcinoma of the oral and maxillofacial region

Background and purposeThis retrospective study was to evaluate the local control and survival of 125I brachytherapy for recurrent and/or locally advanced adenoid cystic carcinoma (ACC) of the oral and maxillofacial region.Patients and methodsA total of 38xa0patients with recurrent and/or locally advanced ACC of the oral and maxillofacial region received 125I brachytherapy alone from 2001–2010. Twenty-nine were recurrent cases following previous surgery and radiation therapy. The other 9xa0cases involved primary tumors. Overall, 12xa0tumors were located in the major salivary glands, 12 in the minor salivary glands, and 14 in the paranasal region, the nasal cavity or the skull base. The prescribed dose was 100–160xa0Gy.ResultsPatients were followed for 12–122xa0months (median 51xa0months). The 2-, 5-, and 10-year local tumor control rates were 86.3, 59, and 31.5u2009%, respectively. The 2-, 5-, and 10-year overall survival rates were 92.1, 65 and 34.1u2009%, respectively. Tumors >u20096xa0cm had significantly lower local control and survival rates. No severe complications were observed during follow-up.Conclusion125I brachytherapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent ACC.ZusammenfassungHintergrund und ZielDiese retrospektive Studie untersucht die lokale Kontrolle und Überlebensrate durch Brachytherapie mit 125I für das rezidivierte und/oder lokal fortgeschrittene adenoid-zystische Karzinom (ACC) der oralen und maxillofazialen Region.Patienten und MethodenVon 2001 bis 2010 wurden 38xa0Patienten mit rezidiviertem und/oder lokal fortgeschrittenem ACC im Mund, -Kiefer- und Gesichtsbereich durch 125I-Brachytherapie behandelt. Davon handelte es sich in 29xa0Fällen um Rezidive nach chirurgischer Tumorentfernung und Strahlentherapie. Die übrigen 9xa0Fälle waren primäre Tumormanifestationen. Bei 12xa0Patienten war die Tumorlokalisation in den großen Speicheldrüsen, bei weiteren 12xa0Patienten in den kleinen Speicheldrüsen und bei 14xa0Patienten in der paranasalen Region, der Nasenhöhle oder der Schädelbasis. Die applizierte Strahlendosis betrug zwischen 100 und 160xa0Gy. Der Beobachtungszeitraum lag zwischen 12 und 122xa0Monaten (Median 51xa0Monate).ErgebnisseBei den lokalen Tumorkontrollen nach 2, 5 und 10xa0Jahren waren jeweils 86,3%, 59% und 31,5u2009% tumorfrei. Die 2-, 5- und 10-Jahres-Überlebensraten betrugen 92,1%, 65% und 34,1u2009%. Tumoren >u20096xa0cm zeigten signifikant niedrigere lokale Tumorfreiheit und niedrigere Überlebensraten. Während des Follow-up-Zeitraums wurden keine schweren Komplikationen beobachtet.FazitDie 125I-Brachytherapie ist praktikabel, wirksam und stellt eine Modalität in der Behandlung eines lokal fortgeschrittenem inoperablem oder rezidiviertem ACC dar.

Clinicopathological characteristics of immunoglobulin G4-related sialadenitis

IntroductionImmunoglobulin G4-related disease (IgG4-RD) is a newly recognized fibro-inflammatory condition. Forty-two cases with immunoglobulin G4-related sialadenitis (IgG4-RS) confirmed by histopathological and immunohistochemical assessment were studied to clarify the clinicopathologic characteristics of the salivary glands involved in IgG4-RS, especially the relationship between the histopathologic features and function of salivary glands or serum levels of IgG4.MethodsClinical, serologic, imaging and histopathological data of these cases were analyzed. CT volumes of submandibular, parotid, and lacrimal glands were calculated. The saliva flow rate was measured. Scintigraphy with 99mTc-pertechnetate was undertaken in 31 cases, and the concentration index (CI) and secretion index (SI) was calculated. Relationships between fibrosis severity and salivary gland function or serum IgG4 levels were analyzed.ResultsThe first symptom was swelling of bilateral submandibular or lacrimal glands. Physical examination showed multiple bilateral major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands were enlarged in IgG4 RS. Multiple enlarged cervical lymph nodes were noted in 30 patients. Saliva flow at rest was lower than normal in 34 cases; stimulated saliva flow was lower than normal in 15 cases. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in 95.2% of cases and 78.6% patients had increased IgE levels. Serum IgG4 level was higher and saliva secretion lower as glandular fibrosis increased.ConclusionsProminent changes in the morphology, histology, immunohistochemistry and secretion of the major salivary glands of IgG4-RS patients were accompanied by involvement of the lacrimal glands and cervical lymph nodes. Elevated IgE, allergic history, eosinophil infiltration suggest allergic reactions as a potential pathogenesis of IgG4-RS. Severity of glandular fibrosis correlated with salivary function and serum levels of IgG4.

The incidence of radioepidermitis and the dose-response relationship in parotid gland cancer patients treated with 125I seed brachytherapy: incidence of radioepidermitis and the dose-response relationship.

BackgroundWe studied the incidence and dose–response relationship of radioepidermitis in parotid gland carcinoma patients treated with [125I] seed brachytherapy in the hopes of designing an optimized pre-implant treatment plan that would reduce the incidence and severity of radioepidermitis in patients receiving this therapy.Patients and methodsBetween January 2007 and May 2010, 100 parotid gland cancer patients were treated postoperatively with [125I] seed brachytherapy. The matched peripheral dose (MPD) was 80–140xa0Gy, and [125I] seed activity was 0.7–0.8xa0mCi. The mean dose delivered to the skin was calculated in the post-implant CT on dayxa00 following implantation. Grades of acute and late dermatitis were evaluated at 2, 6, 12, and 18xa0months post-implantation.ResultsMost patients experienced grade 0–2 acute and late skin side effects (86 and 97u2009%, respectively), though a small subset developed severe complications. Most grade 1–3xa0effects resolved within 6xa0months of implantation, though some grade 1–3xa0effects and all gradexa04 effects remained unchanged throughout the 18-month follow-up period. Grade 3 and 4 effects were most prominent (75 and 25u2009%, respectively) with doses of 110–140xa0Gy; doses higher than 140xa0Gy produced only gradexa04 effects.Conclusion[125I] seed brachytherapy produced acceptable levels of acute and late radioepidermitis with a good clinical outcome. A mean dose under 100xa0Gy delivered to the skin was safe, though doses of 110–140xa0Gy should be given with caution and extra monitoring; doses greater than 140xa0Gy are dangerous and likely to produce gradexa04–5 effects.ZusammenfassungHintergrundWir untersuchten die Inzidenz und die Dosis-Wirkung-Beziehung bei Patienten mit Ohrspeicheldrüsenkrebs, die mit [125I]-Seed-Brachytherapie behandelt wurden, in der Hoffnung, eine optimierte präimplantologische Behandlung zu entwickeln, welche die Inzidenz und Schwere der Radioepidermitis bei Patienten, die diese Therapie erhalten haben, reduziert.Patienten und MethodenZwischen Januar 2007 und Mai 2010 wurden 100xa0Patienten mit Ohrspeicheldrüsenkrebs postoperativ mit [125I]-Seed-Brachytherapie behandelt. Die angeglichene periphere Dosis (MPD) betrug 80–140xa0Gy und die Aktivität der [125I]-Seed war 0,7–0,8xa0mCi. Die durchschnittliche Dosis, die auf die Haut gebracht wurde, wurde beim postimplantologischen CT am Tagxa00 nach der Implantation kalkuliert. Die Grade von akuter und verspäteter Dermatitis wurden nach 2, 6, 12 und 18xa0Monaten postimplantologisch ausgewertet.ErgebnisseDie meisten Patienten erlebten akute und verspätete Nebenwirkungen (86u2009% bzw. 97u2009%) auf der Haut vom Grad 0–2, obwohl eine kleine Untergruppe schwere Komplikationen entwickelte. Die meisten Grad-1- bis Grad-3-Wirkungen hatten sich innerhalb von 6xa0Monaten nach der Implantation aufgelöst, obwohl einige der Grad-3- bis Grad-4-Wirkungen und alle Grad-4-Wirkungen während des 18-monatigen Nachfolgezeitraums unverändert geblieben sind. Die Grad-3- bis Grad-4-Wirkungen waren am bedeutendsten (75u2009% bzw. 25u2009%) mit der Dosis von 110–140xa0Gy; eine Dosis höher als 140xa0Gy erzeugte nur Grad-4-Wirkungen.SchlussfolgerungDie [125I]-Seed-Brachytherapie erzeugt akzeptable Ebenen von akuter und verspäteter Radioepidermitis mit einem guten klinischen Ergebnis. Eine durchschnittliche Dosis unter 100xa0Gy, die auf die Haut aufgebracht wurde, war sicher, obwohl Dosen von 110–140xa0Gy mit Vorsicht und zusätzlicher Überwachung gegeben werden sollten; Dosen höher als 140xa0Gy sind gefährlich und werden wahrscheinlich Grad-4-Wirkungen erzeugen.

Brachytherapy for recurrent malignant tumours of the parotid gland.

To find out if brachytherapy with radioactive seeds was effective in patients with recurrent malignant tumours of the parotid gland we retrospectively studied 64 such patients, 24 of whom were treated with implantation of radioactive seeds alone, and 40 of whom had their recurrent tumours resected followed by implantation of radioactive seeds. Patients were followed up for a mean of 50 months (range 4 months to 12 years). The local control rate was 76.6%, and overall survival 79.7%. Of the 24 patients treated with brachytherapy alone, 22 achieved a complete response (91.7%). At 1, 3, and 5 years the local control rates were 81.5%, 67.2%, and 53.8%, respectively, and the overall survival 82.7%, 70%, and 61.2%, respectively. In the 40 patients whose tumours were resected before brachytherapy, the local control rates at 1, 3, and 5 years were 87.5%, 82.4%, and 78.6%, respectively, and the overall survival was 97.5%, 86.5%, and 86.5%, respectively. Sex, age, histopathological grade, size of tumour, history of radiotherapy, time of recurrence and method of treatment were not shown to have a significant effect on local control, but method of treatment had a significant impact on overall survival (p=0.008). We conclude that treatment of recurrent malignant tumours of the parotid efficacy can be successfully treated with brachytherapy with radioactive seeds, either alone or combined with resection.

Iodine-125 brachytherapy alone for advanced primary parotid gland carcinoma.

This study aimed to evaluate the efficacy of iodine-125 (125I) brachytherapy alone for the treatment of advanced parotid gland carcinoma and to identify predictors of tumour control and patient survival. Primary parotid gland carcinoma patients (n=23) treated with 125I brachytherapy alone between 1 October 2005 and 31 July 2013 at Peking University Stomatology Hospital were enrolled in this retrospective study. All had clinical stage IV disease. The prescribed dose was 60-160Gy. The local control rate, survival rate, and predictors of the prognosis were evaluated. Adverse events related to treatment were also noted. The average follow-up time was 29 months (range 9-74 months). Among the 23 patients, six had local failure and 11 died during the follow-up period. The 1-, 3-, and 5-year overall survival rates were 87.0%, 55.4%, and 47.5%, respectively. The 1-, 3-, and 5-year progression-free survival rates were 73.9%, 47.0%, and 39.2%, respectively. The 1-, 3-, and 5-year local control rates were 82.1%, 73.9%, and 73.9%, respectively. Age and distant metastasis were independent predictors of survival, while the preoperative duration of the disease was an independent predictor of local control. The use of 125I seed brachytherapy alone for the treatment of primary parotid gland carcinoma can provide good short-term results without causing any severe side effects.

Postoperative [¹²⁵I] seed brachytherapy in the treatment of acinic cell carcinoma of the parotid gland: with associated risk factors.

BackgroundThis retrospective study was undertaken to analyze data from patients receiving iodine-125 ([125I]) seed brachytherapy postoperatively for the treatment of acinic cell carcinoma (ACC) of the parotid gland along with the following risk factors: residual tumor, recurrent tumor, facial nerve invasion, positive resection margins, advanced tumor stage, or tumor spillage.Patients and methodsTwenty-nine patients with ACC (17 females, 12 males; age range, 13–73 years; median age, 37.3 years) were included. Median follow-up was 58.2 months (range, 14–122 months). Patients received [125I] seed brachytherapy (median actuarial D90, 177xa0Gy) 3–41 days (median, 14 days) following surgery. Radioactivity was 18.5–33.3xa0MBq per seed, and the prescription dose was 80–120xa0Gy.ResultsThe 3-, 5-, and 10-year rates of local control were 93.1, 88.7, and 88.7u2009%, respectively; overall survival was 96.6, 92, and 92u2009%; disease-free survival was 93.1, 88.4, and 88.4u2009%; and freedom from distant metastasis was 96.6, 91.2, and 91.2u2009%. Lymph node metastases were absent in all patients, although two patients died with distant metastases. Facial nerve recovery was quick, and no severe radiotherapy-related complications were noted. Recurrence history, local recurrence, and distant metastasis significantly affected overall survival.ConclusionPostoperative [125I] seed brachytherapy is effective in treating ACC and has minor complications. Patients with a history of recurrence showed poor prognosis and were more likely to experience disease recurrence and develop metastases.ZusammenfassungHintergrund und ZielDiese retrospektive Studie wurde durchgeführt, um die Daten von Patienten zu analysieren, die postoperativ eine Seed-Brachytherapie mit Iod-125 ([125I]) zur Behandlung von Azinuszellkarzinomen der Ohrspeicheldrüse mit begleitenden Risikofaktoren, wie Residualtumor, Rezidivtumor, Invasion in den N. facialis, positive (= nicht tumorfreie) Resektionsränder, fortgeschrittenes Tumorstadium oder lokale Verbreitung von Tumorzellen während der Resektion aufwiesen.Patienten und MethodenIn die Studie wurden 29xa0Patienten mit Azinuszellkarzinom der Ohrspeicheldrüse (17 weiblich, 12 männlich; Altersbereich 13–73xa0Jahre; medianes Alter 37,3xa0Jahre) eingeschlossen. Die mediane Nachbeobachtungszeit betrug 58,2xa0Monate (Spanne14–122xa0Monate). Die Patienten erhielten eine [125I]-Seed-Brachytherapie an den Tagen 3–41 (Median 14xa0Tage) nach der Operation. Die Radioaktivität betrug 18,5–33,3xa0MBq/Seed, die Dosis lag bei 80–120xa0Gy.ErgebnisseDie lokalen 3-, 5- und 10-Jahres-Kontrollraten lagen jeweils bei 93,1, 88,7 und 88,7u2009%. Absolute Überlebensrate: 96,6, 92 und 92u2009%. Krankheitsfreie Überlebensrate: 93,1, 88,4 und 88,4u2009%. Ohne Fernmetastasierung: 96,6, 91,2 und 91,2u2009%. Lymphknotenmetastasen traten bei keinem Patienten auf, wogegen 2xa0Patienten mit Fernmetastasen starben. Die Erholung des N. facialis war schnell und es wurden keine ernsthaften, mit der Radiotherapie in Zusammenhang stehenden Komplikationen bemerkt. Lagen bereits vorher Rezidive, Lokalrezidive oder Fernmetastasen vor, so beeinflusste dies signifikant die absolute ÜberlebensrateSchlussfolgerungDie Brachytherapie mit [125I]-Seeds ist eine effektive Behandlung der Azinuszellkarzinome der Ohrspeicheldrüse mit geringer Komplikationsrate. Patienten, die in der Vergangenheit schon ein Rezidiv gehabt hatten, hatten eine schlechte Prognose und entwickelten mit größerer Wahrscheinlichkeit erneut oder zum ersten Mal Metastasen.