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Proton Beam Radiation Therapy for Skull Base Adenoid Cystic Carcinoma
Pascal Pommier, MD;
Nobert J. Liebsch, MD, PhD;
Daniel G. Deschler, MD;
Derrick T. Lin, MD;
James F. McIntyre, MD;
Fred G. Barker II, MD;
Judy A. Adams, CMD;
Vrishali V. Lopes, MS;
Mark Varvares, MD;
Jay S. Loeffler, MD;
Annie W. Chan, MD
Arch Otolaryngol Head Neck Surg. 2006;132:1242-1249.
Objective To determine the treatment outcome and prognostic factors in patients with adenoid cystic carcinoma of the skull base treated with proton beam radiation therapy.
Design Retrospective analysis.
Setting Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston.
Patients From 1991 to 2002, 23 patients with newly diagnosed adenoid cystic carcinoma with skull base extension were treated with combined proton and photon radiotherapy. There was tumor involvement of the sphenoid sinus in 61% of patients (14), nasopharynx in 61% (14), clivus in 48% (11), and cavernous sinus in 74% (17). The extent of surgery was biopsy alone in 48% (11), partial resection in 39% (9), and gross total resection with positive margins in 13% (3). The median total dose to the primary site was 75.9 cobalt-gray equivalent. The median follow-up of all surviving patients was 64 months.
Main Outcome Measures Locoregional control and disease-free survival and overall survival rates.
Results Tumors recurred locally in 2 patients at 33 and 68 months, respectively. No patients developed neck recurrence. Eight patients had distant metastasis as the first site of recurrence. The local control rate at 5 years was 93%. The rate of freedom from distant metastasis at 5 years was 62%. The disease-free and overall survival rates at 5 years were 56% and 77%, respectively. In multivariate analysis, significant adverse factors predictive for overall survival were change in vision at presentation (P = .02) and involvement of sphenoid sinus and clivus (P = .01).
Conclusions High-dose conformal proton beam radiation therapy results in a very encouraging local control rate in patients with adenoid cystic carcinoma of the skull base. Changes in vision at presentation and tumor involvement of the sphenoid sinus and clivus are important prognostic factors.
Author Affiliations: Departments of Radiation Oncology (Drs Pommier, Liebsch, McIntyre, Loeffler, and Chan and Mss Adams and Lopes) and Neurosurgery (Dr Barker), Massachusetts General Hospital, Boston; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston (Drs Lin and Varvares); Francis H. Burr Proton Therapy Center, Harvard Medical School, Boston (Drs Pommier, Liebsch, McIntyre, Loeffler, and Chan and Mss Adams and Lopes); and Department of Radiation Oncology, Centre Leon Berard, Lyon, France (Dr Pommier). Dr McIntyre is now with the North Shore Medical Center Cancer Center, Peabody, Mass. Dr Varvares is now with the Department of Otolaryngology, Saint Louis University, St Louis, Mo.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
REFERENCES
JOURNAL OF THE ICRU 2007;7:189-210.
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