Adenoid Carcinoma Research Articles

Radiotherapy for parotid cancer: 10 years of experience in a single center

<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>

Chemoradiation Therapy as the Treatment of the Adenoide Cystic Cancer of the Bartholin Gland : About One Case Report and Review of the Literature

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare yet clinically significant malignancy Originating from the Bartholin's gland, situated in the vulvar region, ACC exhibits unique histopathological features and clinical behaviors. In our article, we describe a clinical case involving a 28-year-old female patient who initially presented with a painful swelling on the left labia majora. Initially misdiagnosed as simple Bartholin's gland inflammation, biopsy revealed cystic adenoid carcinoma of the Bartholin gland upon histopathological examination. Radiological evaluation revealed a locally advanced left vulvar lesion with no evidence of distant metastasis. Given the impracticability of surgical intervention, concurrent chemoradiation therapy was administered, resulting in favorable outcomes. ACC has been a diagnostic therapeutic challenge, there is currently no established therapeutic standard. Despite its infrequent occurrence, ACC warrants attention due to its potential for aggressive local invasion, distant metastasis, and propensity for recurrence.

Tracheal cancer epidemiology and survival trends: A SEER database analysis.

e20078 Background: Tracheal cancer is one of the rarest malignancies of the respiratory system and, hence one of the least studied ones. It has a poor prognosis and understanding its epidemiology can help with effective diagnosis and management. Here we present the Surveillance, Epidemiology, and End Results (SEER) analysis of tracheal cancer. Methods: Information was obtained from the SEER database November 2022 with 17 registries for years 2000-2022. Case selection was done for the Primary labeled site Trachea C 33.9. Only patients with age >20 years and with one primary cancer were included. A total of 537 Patients were analyzed for incidence and survival based on Histology, Age, Gender, Race, Household Income, Area of residence, and treatment received. Results: The most common histology was squamous cell carcinoma (34%),followed by adenoid cystic carcinoma (23%) and Small cell carcinoma (4%). Other histologies (39%) included but were not limited to Large cell carcinoma, adenoid carcinoma, mucoepidermoid carcinoma, etc. The age group studied was 15 years and above. The most common age group affected was 65-69 years (12.3%), closely followed by 60-64 years (12.1%). The mean age of population was 62.5 +/- 14.7 years. Out of the total,56% were males and 44% were females (P value (P) < 0.002). 68.7% of cases were observed in Non-Hispanic Whites, (P <0.0001) followed by Blacks (11.4%), Hispanics (9.3%), Asian/Pacific Islanders (9.9%). 83% of the population was residing in metropolitan versus 17% in non-metropolitan regions (P<0.0001). 38% cases were observed in Annual household Income of >75,000 US dollars (USD) versus 62% in <75,000 USD (P <0.0006). Overall 5-year survival of tracheal cancer was noted to be 27%. Surgery was done in 40% of the cases. Poor 5-year survival was observed in those who did not have surgery compared to those who did(Hazard ratio (HR)=1.45, Confidence Interval (CI) 1.23-1.71, P <0.0001). Radiation was done in 28.1% of cases. Patients who received no radiation therapy had poor outcome compared to those who did. (HR=1.214, CI 1.066-1.383, P <0.0001). White race had worse outcomes compared to other races (HR 1.14, CI 1.003-1.289, P<0.023). The risk of death at 5 years in Males was slightly higher than in females but not statistically significant (HR 1.067, CI 0.96-1.18). Difference was also not significant in those with Household income <75,000 USD compared to those with more than >75,000 USD (HR 0.92 CI 0.83-1.01), Metropolitan versus non-metropolitan areas of residence (P=0.14). Conclusions: Statistically significant improvement in survival has been noted in patients who received the treatments including surgery or radiation in tracheal cancer versus patients who didn’t. Our study suggests that less than half of the patients received surgery and less than one-third of the patients received radiation therapy. Efforts should be made to emphasize the continued utilization of these therapy options for better outcomes.

Challenging the Role of Subtotal Resection Following Proton Radiotherapy for Adenoid Cystic Carcinoma of the Head and Neck

To report long-term outcomes of patients with adenoid cystic carcinoma (ACC) of the head and neck treated with proton radiotherapy. On this IRB-approved, single institutional prospective outcomes registry, 56 patients were included with de novo, nonmetastatic adenoid carcinoma of the head and neck treated with primary (n = 9) or adjuvant proton therapy from June 2007 to December 2021. The cohort had 30 women and 26 men with a median age of 57 years (range, 10-81 years). Twenty-nine percent (n = 16) had intracranial extension, 23% (n = 13) had orbital extension, and 55% (n = 31) had clinical cranial nerve involvement at the time of radiotherapy. Thirty patients underwent gross total resection (GTR), 26 had gross disease at the time of treatment undergoing a subtotal resection (STR) (n = 17) or biopsy alone (n = 9). The median dose to the primary site was 72.6 GyRBE (range, 64-74.4 GyRBE) delivered in either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received either elective nodal irradiation (ENI) in a node negative neck or concurrent chemotherapy. With a median follow-up of 6.2 years (range, 0.9 - 14.7 years), the 5-year local-regional control (LRC), disease free survival (DFS), cause-specific survival (CCS) and overall survival (OS) were 88%, 85%, 89%, and 89%, respectively. Cranial extension (p = 0.003) and gross residual tumor (p = 0.0388) were factors associated with decreased LRC. While LRC for those with a GTR was 96%, those with STR or biopsy alone were 81% and 76%, respectively. T-stage (p = 0.0154), cranial extension (p = 0.0056), extent of resection (p = 0.0355), and gross residual tumor (p = 0.0094) were associated with decreased DFS. T-stage (p = 0.0099), extent of surgery (p = 0.029) and gross residual tumor (p.0071) were associated with decreased CCS. The 5-year cumulative incidence of clinically significant late grade ³3 toxicity was 15% and the crude incidence at most recent follow-up was 23% (n = 13). There was no LRC benefit with ENI (p = 0.94). Proton therapy provides excellent disease control for head and neck ACC with acceptable toxicity. Gross residual disease at the time of treatment and intracranial involvement were significant prognostic features for worse outcomes. STR did not confer benefit over biopsy only at 5-years and may question the role of extensive and morbid operations if GTR is not technically feasible.

OSTEORADIONECROSIS IN PATIENTS IRRADIATED IN THE HEAD AND NECK REGION - A CASE SERIES

This study aimed to describe 21 cases of osteoradionecrosis (ORN) in patients undergoing radiotherapy in the head and neck region. ORN cases diagnosed between January 2010 and December 2020 in a southern Brazil hospital were selected. ORN demographic data and clinical features were collected. Men (n=16/76.2%) with a mean age of 60.9 (34.5; 70.9) years were more affected. The tumor's primary sites were the mouth (n=12), oropharynx (n=7), hypopharynx (n=1), and skin (n=1), with Squamous Cell Carcinoma (n=19), Cystic Adenoid Carcinoma (n=1), and Adenocarcinoma (n=1) diagnoses. The mandible was the most affected location (n=19/90.48%), with an average time of ORN development of 60.9 (2.1; 80.3) months after radiotherapy treatment. In 13 (61.9%) patients, post-radiotherapy tooth extractions were performed and were considered the triggering factor. ORN is more common in the mandible of male patients undergoing tooth extraction after radiotherapy. Dental evaluation prior to radiotherapy treatment is necessary to minimize ORN development. This study aimed to describe 21 cases of osteoradionecrosis (ORN) in patients undergoing radiotherapy in the head and neck region. ORN cases diagnosed between January 2010 and December 2020 in a southern Brazil hospital were selected. ORN demographic data and clinical features were collected. Men (n=16/76.2%) with a mean age of 60.9 (34.5; 70.9) years were more affected. The tumor's primary sites were the mouth (n=12), oropharynx (n=7), hypopharynx (n=1), and skin (n=1), with Squamous Cell Carcinoma (n=19), Cystic Adenoid Carcinoma (n=1), and Adenocarcinoma (n=1) diagnoses. The mandible was the most affected location (n=19/90.48%), with an average time of ORN development of 60.9 (2.1; 80.3) months after radiotherapy treatment. In 13 (61.9%) patients, post-radiotherapy tooth extractions were performed and were considered the triggering factor. ORN is more common in the mandible of male patients undergoing tooth extraction after radiotherapy. Dental evaluation prior to radiotherapy treatment is necessary to minimize ORN development.

Incomplete cavernous sinus syndrome with cystic adenoid carcinoma of the palate

Incomplete cavernous sinus syndrome with cystic adenoid carcinoma of the palate

STUDY OF IMMUNOHISTOCHEMICAL MARKERS RELATED TO EPITHELIAL-MESENCHYMAL TRANSITION IN SALIVARY GLAND TUMORS

Objectives To analyze the protein expression and identify the localization of cellular markers related to the epithelial-mesenchymal transition process in salivary gland tumors. Study Design The expression and localization of E-cadherin, N-cadherin, SLUG, SNAIL, and TWIST were evaluated using immunohistochemistry in 48 salivary gland tumors: 17 pleomorphic adenomas, 14 cystic adenoid carcinomas (CAC), 17 mucoepidermoid carcinomas (MEC), as well as in 7 samples of normal gland tissue. Results A low expression of E-cadherin was observed in most of the evaluated tumors and a high expression of N-cadherin in malignant tumors but without statistical significance. In addition, there were statistically significant differences in the expression of SNAIL (P = .03), SLUG (P = .03), and TWIST (P = .01) in the tumor parenchyma of the MEC, as well as a high expression of the SNAIL (P = .02) in the parenchyma cases of CAC. Conclusions We observed changes in the expression of protein markers, especially SNAIL, SLUG, and TWIST, in the evaluated malignant tumors. These transcription factors are important in the epithelial-mesenchymal transition process and are possibly related to the development of a more invasive tumor phenotype. To analyze the protein expression and identify the localization of cellular markers related to the epithelial-mesenchymal transition process in salivary gland tumors. The expression and localization of E-cadherin, N-cadherin, SLUG, SNAIL, and TWIST were evaluated using immunohistochemistry in 48 salivary gland tumors: 17 pleomorphic adenomas, 14 cystic adenoid carcinomas (CAC), 17 mucoepidermoid carcinomas (MEC), as well as in 7 samples of normal gland tissue. A low expression of E-cadherin was observed in most of the evaluated tumors and a high expression of N-cadherin in malignant tumors but without statistical significance. In addition, there were statistically significant differences in the expression of SNAIL (P = .03), SLUG (P = .03), and TWIST (P = .01) in the tumor parenchyma of the MEC, as well as a high expression of the SNAIL (P = .02) in the parenchyma cases of CAC. We observed changes in the expression of protein markers, especially SNAIL, SLUG, and TWIST, in the evaluated malignant tumors. These transcription factors are important in the epithelial-mesenchymal transition process and are possibly related to the development of a more invasive tumor phenotype.

Abstract 1916: Using systems medicine for comprehensive metabolic profiling of tumors: how tumor metabolism shapes prognosis and response to chemotherapy

Abstract Background: Metabolic disfunction is one of the hallmarks of cancer, and metabolism-based therapies are a key class of chemotherapeutics. Despite this, there has previously been no systematic way to identify metabolism-based targets for therapeutic intervention. This is especially concerning when considering that targeting tumor metabolism has been shown to increase the efficacy of standard chemotherapy in pre-clinical studies. We therefore developed a systems medicine approach to interrogate tumor metabolism systematically, identify the effects of metabolic heterogeneity on overall survival prognosis, and gain insights into new metabolism-associated targets or therapies to complement standard of care for cancer patients. Method: Our systems medicine framework statistically integrates metabolic network modeling with RNA-sequencing data (RNA-seq). This allows us to integrate molecular data about individual tumors (from RNA-seq) with a curated knowledge base of how these molecules interact within a patient’s tumor (using metabolic network models). This results in a mathematical description, or model, of a specific tumor’s metabolism that is able to be interrogated (i.e., it is high-dimensional like RNA-seq data) and able to be simulated (i.e., we can “drug” the model and investigate downstream effects). Results: We applied this systems medicine approach across a range of tumor types, including lung adenocarcinoma, pancreatic adenocarcinoma, metastatic melanoma, clear cell renal cell carcinoma, and salivary cystic adenoid carcinoma. Within each cancer type, we found significant patient-to-patient metabolic heterogeneity. Across cancer types, a consistent pattern that emerged was that the metabolic systems with the most patient-to-patient heterogeneity were also the systems most associated with patient overall survival. This result suggests that metabolic variability is a key driver of tumor response to therapy and overall patient survival. Furthermore, targeting metabolic pathways in a patient-specific manner could enhance chemotherapy in tumors with metabolic profiles associated with poor prognosis. Conclusion: This study shows that the specific metabolic profiles of tumors are key drivers of overall survival. We therefore believe that metabolic tumor characterization and intervention could be a useful strategy to enhance chemotherapy efficacy and overall survival in patients across tumor types. Citation Format: Daniel Cook, John A. Cole, Patricia Carrigan, Joseph R. Peterson, The SimBiosys Team. Using systems medicine for comprehensive metabolic profiling of tumors: how tumor metabolism shapes prognosis and response to chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1916.

Adenoid Cystic Carcinoma of the Bartholin Gland a Rare Tumor: A Case Report

Introduction: cystic adenoid carcinoma of the Bartholin gland is a very rare tumor with a low incidence of 1% of female genital malignancies; it is characterized by its aggressive nature and frequent recurrence. Case report: We report a case of a cystic adenoid carcinoma of Bartholin's gland in a 38-year-old female patient who was treated surgically with good evolution. Conclusion: Adenoid cystic carcinoma is a very rare tumor of the Bartholin gland, whose diagnosis is based on the anatomopathological study.

Degeneration of a Huge Pleomorphic Adenoma in the Nasal Cavity Extended to the Hard Palate: A Case Report and Review of the Literature.

The pleomorphic adenoma is a benign tumor. The patient was 55years old, with no particular pathological history. For 18months, she had a progressive and permanent right nasal obstruction associated with intermittent epistaxis, rhinorrhea and chronic unilateral tearing. The nasofibroscopy showed a smooth reddish bleeding tumor of the right nasal cavity, reaching the lower part of the middle cornet. Oropharynx examination revealed on the right side a sessile and bulging tumor of the palate with respect of the mucosa, the tumor goes through the choanae into the oropharynx. The CT scan showed a large aggressive lesion process centered on the right nasal cavity with bone lysis of the posterolateral wall of the maxillary sinus and invasion of the infratemporal fossa. MRI showed a maxillary right naso-sinusal tumor process infiltrating the ethmoidal cells, the right infratemporal fossa with endobuccal extension and filling the nasopharyngeal lumen. The patient was operated through the right external para-latero-nasal, associated to an endonasal abord. Anatomo-pathological with immune-histochemical study was performed to ensure complete removal of the tumor and it showed a high grade cystic adenoid carcinoma.

Clinicopathological features of basal cell type dysplasia of esophagus

Objective: To investigate the clinicpathological features of basal cell type dysplasia of the esophagus. Methods: The clinicopathological data of 71 cases of basal cell type dysplasia of esophagus were collected at the People's Liberation Army Joint Logistics Support Force 989 Hospital, from 2009 to 2019, and the histomorphologic characteristics and immunophenotype were evaluated. The relevant literature was reviewed. Results: The ratio of male to female patients was 1.6∶1.0, and the median age was 65 years (range 48-81 years). The tumors were located in the upper segment of the esophagus in four cases (5.6%), the middle segment in 54 cases (76.1%), and the lower segment in 13 cases (18.3%).The median maximal tumor diameter was 12.0 mm (range 3-42 mm). According to Paris Classification, 0-Ⅱb accounted for 42.3% (30/71) of the cases. Under endoscope, the lesions were reddish with abnormal mucosal microvessels. Histologically, the neoplastic cells were small, with a high nuclear-cytoplasmic ratio, similar to basal cells, and uniform in morphology. The structural atypia was characterized by dense and disordered tumor cells, loss of basal cell polarity, and absence of normal squamous differentiation gradient. In 10 cases, the tumors were confined to the lower part of the epithelium. The tumor cells were smaller and more uniform in shape, and extend to the superficial lamina propria. Sixty-one tumors involved at least the entire layer of the upper cortex. There were 31 cases of neoplasms with superficial invasive carcinoma. The types of neoplasms included typical squamous cell carcinoma, basaloid squamous cell carcinoma, small cell neuroendocrine carcinoma, squamous cell carcinoma with sebaceous adenoid carcinoma, and differentiation of glandular/ductal epithelioid carcinoma. Immunohistochemical staining showed that the mutant expression rate of p53 protein was 41.5% (17/41). All 41 cases (100.0%) showed abnormal distribution pattern of Ki-67. According to the initial pathologic diagnosis, there were 18 cases of low grade dysplasia, 12 cases of atypical epithelial cells, and 41 cases of high grade dysplasia and superficially invasive carcinoma. Conclusions: Basal cell type dysplasia has unique morphologic characteristics and represents a tumor subtype in the morphologic lineage of esophageal squamous dysplasia. Tumor cells of basal cell type dysplasia, especially those distributed only in the lower part of the stratified squamous epithelium, may be tumor stem cells at the earliest stage of esophageal carcinogenesis and have multidirectional differentiation potential. When the tumor is confined to the lower part of the stratified squamous epithelium, it does not meet the diagnostic criteria for esophageal squamous dysplasia as defined by the current WHO classification.

Cystic Adenoid Carcinomas in Ear, Nose and Throat: Unusual Localizations and a Literature Review

Introduction: adenoid cystic carcinoma account 1% for all cancers of the ear nose and throat. Despite slow growth, their recurrence is frequent. This study concerns 5 cases of cystic adenoid carcinoma with atypical ear nose and throat locations (outside the main salivary glands).
 Materials and methods: Our work is a study of 5 cases of cylindromes with atypical localizations collected at the ear nose throat and cervico-facial surgery department of Mohamed IV university hospital of Marrakesh: 1 case located at the external auditory meatus, 1 case at the infratemporal fossa, 1 case on the inside of the cheek, 1 case in the soft palate and one laryngotracheal case.
 Results and discussion: The management of adenoid cystic carcinoma remains delicate because of their insidious growth, their neurological tropism and their metastatic potential. These associated elements delay the diagnosis that is often made while those tumors are locally advanced, which can make surgery difficult, and be responsible of a lot of late recurrences. The treatment of these tumors has long relied on exclusive surgery. Cystic adenoid carcinomas were considered radio resistant. Retrospective studies have shown the benefit of treatment combining surgery and radiotherapy, in terms of local control and disease-free survival, compared to surgery or radiotherapy alone.
 Conclusion: The essential problem of adenoid cystic carcinoma remains the long-term control of the disease. Our results confirm that the gold-standard treatment should be both surgery and radiotherapy.

A Case Report of a Primary Cutaneous Adenoid Carcinoma: A Diagnostic and Management Challenge

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare glandular neoplasm that mimics benign lesions both clinically and histologically making it a diagnostic challenge. Although indolent, ACC has potential for local regional and distant metastasis and even after surgical excision, there is a high recurrence rate. This report outlines a case of a PPACC and reviews current therapeutic approaches.

The rare Case of Cystic Adenoid Carcinoma of the Larynx Treated by Post Operative Radiation Therapy

Adenoid cystic carcinoma (C.A.K.) is a malignant tumor most commonly developing in the main or accessory salivary glands. The most frequent sites of C.A.K are located in the salivary glands of the oral cavity, in particular in the hard palate and with less frequency in the nasal cavity, paranasal sinuses and pharynx. The laryngeal localization of C.A.K is extremely rare. The cervical scanner is the imaging of choice for the early diagnosis of CAK of the larynx. Diagnosis is made by pathology examination of the biopsy specimen supplemented by immunohistochemistry. We report the case of a 26-years-old patient, who presented for 18 months, progressive dysphagia to solids, and then laryngeal dyspnea requiring emergency tracheotomy. Surgery followed by postoperative radiotherapy was used for treatment.

CYSTIC ADENOID CARCINOMA IN UNCOMMON LOCATION: A CASE REPORT

Cystic adenoid carcinoma (CAC) is a malignant neoplasm of salivary glands that mainly affects the parotid. We report a CAC case in a rare site. A 35-year-old female patient, smoker, was referred to the stomatology clinic with a progressive lesion in the left jugal mucosa. Oroscopy revealed a submucosal nodule, firm and with an evolution of 2 years. Hematologic examinations were requested for the incisional biopsy, which did not present alterations. The histopathologic analysis revealed a malignant neoplasm of glandular epithelium organized in islands and composed of myoepithelial and ductal cells in a pattern sometimes cribriform or tubular with muscular, vascular, and neural invasions concluded as CAC. The patient was referred to the oncology service. Histopathologic analysis is important for the accurate diagnosis of CAC because of the possibility of involvement of unusual regions and the reserved prognosis of the lesion.

CYSTIC ADENOID CARCINOMA OF LARGE EXTENSION IN THE MAXILLA: A CASE REPORT

Cystic adenoid carcinoma (CAC) is a slow-growing, malignant gland neoplasm, with predominance in the palate region. A 54-year-old female patient presented with an extensive ulcerated lesion, with bleeding, painless, endophytic growth, affecting the hard and soft palate, with evolution of 8 months. Image examination showed a hypodense lesion with indefinite limits, involving the palate, the entire nasal cavity, and the left maxillary sinus. After facial clinical and imaging findings were reviewed, incisional biopsy was performed in the peripheral regions of the lesion, and the patient was instructed to suspend the use of the total prosthesis. The histologic examination concluded CAC diagnosis. Because it was a malignant lesion, the patient was referred to a state referral center to continue the treatment. The role of the dentist is of paramount importance in diagnosing and conducting the primary treatment of lesions in the maxillofacial region. Cystic adenoid carcinoma (CAC) is a slow-growing, malignant gland neoplasm, with predominance in the palate region. A 54-year-old female patient presented with an extensive ulcerated lesion, with bleeding, painless, endophytic growth, affecting the hard and soft palate, with evolution of 8 months. Image examination showed a hypodense lesion with indefinite limits, involving the palate, the entire nasal cavity, and the left maxillary sinus. After facial clinical and imaging findings were reviewed, incisional biopsy was performed in the peripheral regions of the lesion, and the patient was instructed to suspend the use of the total prosthesis. The histologic examination concluded CAC diagnosis. Because it was a malignant lesion, the patient was referred to a state referral center to continue the treatment. The role of the dentist is of paramount importance in diagnosing and conducting the primary treatment of lesions in the maxillofacial region.

Cystic Adenoid Carcinoma of the Airway: Multimodal Radiological Approach

Cystic adenoid carcinoma (ACC) is the second most frequent tumor of the pathway. The diagnosis is generally late when the patient is taken to tomography studies; however, in retrospective analysis, the patient often presents findings on the chest radiograph, which were generally omitted. For the radiologist, the diagnostic approach to the airway from radiography to tomography continues to be a challenge, therefore, the objective of the article is to carry out a complete systematic approach to the disease with emphasis on important normal and abnormal imaging findings on radiography and thorax tomography

Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes.

Introduction: Lacrymal cystic adenoid carcinoma is a rare disease for which optimal treatment is still debated. In fact, despite aggressive treatment such as eye sparing surgery or orbital exenteration, following by adjuvant radiotherapy, local recurrence and distant metastatic disease are common. This study aims to describe outcomes of eye surgery associated with high dose exclusive adjuvant proton beam irradiation.Materials and Methods: This is a monocentric institutional retrospective study. We retrospectively reviewed records of patients treated in our institution since 2008 with high dose adjuvant proton irradiation for a lacrymal cystic adenoid carcinoma up to a maximum of 75.6Gy(RBE). Other histologies or patients treated with a mix of photon-proton were excluded. A total of 15 patients were finally included.Results: Fifteen patients (80% women, 100% Performance status 0–1) with locally advanced disease (33% T3–T4, 47% R1–R2) were included. After a median follow-up of 67.4 months [13.4–122] the 3 years Overall Survival, local Progression free survival, and progression free survival rates were 78, 70, and 58%, respectively. Six patients exhibited a local recurrence. All patients with conservative surgery maintained their base-line visual acuity and visual field at last follow up. Four patients developed brain radionecrosis.Conclusion: This is the largest series of patients with ACC treated with high dose adjuvant proton therapy. Proton therapy is a safe and efficient treatment and should be considered as an adjuvant irradiation modality to privilege, for patients with lacrimal ACC after conservative or radical eyeball surgery. Dose delivered to temporal lobe should be limited to avoid brain radionecrosis.

Carcinoma adenoide quístico de cabeza y cuello. Un estudio retrospectivo de 5 años. Experiencia en un centro de referencia de tercer nivel

Adenoid cystic carcinoma (ACC) is a rare tumor, with an annual incidence of 3-4.5 cases/million. We conducted a descriptive and retrospective study. We included patients diagnosed with ACC of head and neck of a single third-level referral center, from January 2008 to December 2013. A total of 23 patients were included in the study, 10 males (43.5%) and 13 females (56.5%) (F:M ratio 1.3:1). Median age was 52 years. Localization was predominantly observed in the oral cavity (26%) followed by the palate (17.4%). At presentation, 15 patients (65.2%) had clinical Stage II. The most frequent histology was the cribriform type in 10 patients (43.5%). Following resection, positive margins were observed in 15 (65.2%), neural invasion in 8 (34.8%), and lymphovascular invasion in 2 (8.7%) patients. The median time to recurrence in our population was 23 months. Recurrence at 5 years was observed in 15 patients (65%). At 2 years, recurrence was predominantly local in 7 patients (46%); whereas after 2 years, it was predominantly pulmonary 6 patients (40%). Overall, 5 year-survival was 78%. Cystic adenoid carcinoma is characterized by a high recurrence rate. Nevertheless, it has a high overall 5-year survival, which justifies an aggressive treatment.

Cystic Adenoid Carcinomas of the Parotid: About 3 Cases and Review of Literature

Adenoids cystic carcinomas (CAKs) represent 2-4% of parotid tumors and 12% of malignant tumors. These are slow growing tumors that are characterized by their ability to infiltrate the nerve sheaths. We collected three cases of CAK of the parotid gland diagnosed and treated between 2012 and 2018. These were 03 women who consulted in front of the appearance of a swelling of the parotid compartment associated with a facial paralysis in a case. The lymph node areas were free. All patients underwent exploration including ultrasound, CT in one case, and MRI in one patient. Treatment consisted of a total parotidectomy associated with lymph node dissection in all cases and additional radiotherapy. The evolution was favorable in two cases. The adenoid cystic carcinoma of the parotid is a rare tumor, characterized by a very slow evolution, a local aggressiveness, a strongly recurrent character locally and a high metastatic capacity at a distance.