Inverse planned stereotactic intensity modulated radiotherapy (IMRT) in the treatment of incompletely and completely resected adenoid cystic carcinomas of the head and neck: initial clinical results and toxicity of treatment

Mw Münter,A Nikoghosyan,H Hof,S Nill,A Jensen,J Debus,D Schulz-Ertner,P Huber

doi:10.1186/1748-717x-1-17

Abstract

BackgroundPresenting the initial clinical results in the treatment of complex shaped adenoid cystic carcinomas (ACC) of the head and neck region by inverse planned stereotactic IMRT.Materials25 patients with huge ACC in different areas of the head and neck were treated. At the time of radiotherapy two patients already suffered from distant metastases. A complete resection of the tumor was possible in only 4 patients. The remaining patients were incompletely resected (R2: 20; R1: 1). 21 patients received an integrated boost IMRT (IBRT), which allow the use of different single doses for different target volumes in one fraction. All patients were treated after inverse treatment planning and stereotactic target point localization.ResultsThe mean folllow-up was 22.8 months (91 – 1490 days). According to Kaplan Meier the three year overall survival rate was 72%. 4 patients died caused by a systemic progression of the disease. The three-year recurrence free survival was according to Kaplan Meier in this group of patients 38%. 3 patients developed an in-field recurrence and 3 patient showed a metastasis in an adjacent lymph node of the head and neck region. One patient with an in-field recurrence and a patient with the lymph node recurrence could be re-treated by radiotherapy. Both patients are now controlled. Acute side effects >Grade II did only appear so far in a small number of patients.ConclusionThe inverse planned stereotactic IMRT is feasible in the treatment of ACC. By using IMRT, high control rates and low side effects could by achieved. Further evaluation concerning the long term follow-up is needed. Due to the technical advantage of IMRT this treatment modality should be used if a particle therapy is not available.

Highlights

Presenting the initial clinical results in the treatment of complex shaped adenoid cystic carcinomas (ACC) of the head and neck region by inverse planned stereotactic intensity modulated radiation therapy (IMRT).Materials: 25 patients with huge ACC in different areas of the head and neck were treated
Adenoid cystic carcinomas of the head and neck are a unique kind of tumour deriving from cells of the major and minor salivary glands, they account for 25% of all malignant salivary gland tumours in different series
In one patient with an macroscopic ACC the dose of the CTV I was lower than 60 Gy due to a diffuse infiltrating tumor with a close relationship to the myelon and the brainstem

Summary

Introduction

Presenting the initial clinical results in the treatment of complex shaped adenoid cystic carcinomas (ACC) of the head and neck region by inverse planned stereotactic IMRT.Materials: 25 patients with huge ACC in different areas of the head and neck were treated. Presenting the initial clinical results in the treatment of complex shaped adenoid cystic carcinomas (ACC) of the head and neck region by inverse planned stereotactic IMRT. Adenoid cystic carcinomas of the head and neck are a unique kind of tumour deriving from cells of the major and minor salivary glands, they account for 25% of all malignant salivary gland tumours in different series. When compared to other malignancies, a prolonged survival of patients with ACCs is possible even in case of local recurrence or distant metastases. ACCs characteristically exhibit a locally aggressive growth pattern with a unique tendency to nervous tissue invasion. They might spread greater distances from the primary location by growing along the nerve sheaths. Skip involvement can be seen along the perineural space

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