质子束治疗的头颈部腺样囊性癌患者的预后因素和临床结果：来自意大利转诊中心的见解。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-14 DOI:10.1016/j.radonc.2025.111143

Barbara Vischioni , Maria Bonora , Giulia Fontana , Sara Scardo , Laura Brighenti , Luca D’Ambrosio , Sara Ronchi , Rossana Ingargiola , Anna Maria Camarda , Sara Imparato , Nadia Facchinetti , Alessandro Vai , Mario Ciocca , Silvia Molinelli , Ester Orlandi

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引用次数: 0

摘要

目的：头颈腺样囊癌（ACC）是一种罕见的肿瘤，具有侵袭周围神经和局部复发的倾向，难以治愈。我们的研究旨在报告在我们中心接受治疗性质子疗法（PT）治疗的一大批accp患者的临床结果和预后因素。方法和材料:在2017年至2022年之间,129年ACC患者接受治疗PT,在术后(n = 104:R0 / R1 = 74 R2 = 30)和激进的设置(n = 25),与59.4 - -74.2 Gy相对生物效应剂量,在28-37分数。评估生存结局、毒性以及关键队列特征对结局和毒性的影响（α = 0.05）。结果:平均随访34 月,总生存期(OS),无病生存期(DFS),局部控制(LC),和遥远的Metastasis-Free生存(时间)2 -,3 -,和包括5年94.2 %, % 89.4和86.7 %,77.5 % 76.4 % 64 %,92.4 % 90.8 % 84 %,77.4 %,分别76.3 %和66.6 %。先进的T台(HR = 4.99,p = 0.002和HR = 4.76,p = 0.022),和坚实的组织学亚型(HR = 3.27,p = 0.004和HR = 3.76,p = 0.002)负面影响DFS和混杂因素调整后出现时间多变量分析。对于DFS，在单变量分析中，手术缘R0/R1与未切除患者相比正影响LC (p = 0.042)，而R2与未切除患者的HR相似（p = 0.8）。记录的最大毒性等级为G3，急性11级，晚期9级。未见G3脑放射性坏死。结论：PT治疗手部ACC有效，毒性负担有限。确定预后因素对正确治疗至关重要。在无法切除的情况下，PT可以作为减体积手术的替代方案。

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Prognostic factors and clinical outcomes in a large cohort of head and neck adenoid cystic carcinoma patients treated with proton beam therapy: Insights from an Italian referral center

Purpose

Head and neck adenoid cystic carcinoma (ACC) is a rare tumor, challenging to be cured for the tendency to perineural invasion and local recurrence. Our study aimed to report clinical outcomes and prognostic factors in a large cohort of ACC patients treated with curative proton therapy (PT) at our center.

Methods and materials

Between 2017 and 2022, 129 ACC patients were treated with curative PT, both in postoperative (n = 104: R0/R1 = 74, R2 = 30) and radical settings (n = 25), with 59.4–74.2 Gy Relative Biological Effectiveness dose, in 28–37 fractions. Survival outcomes, toxicities, and the impact of key cohort characteristics on outcomes and toxicities were evaluated (α = 0.05).

Results

With 34 months of median follow-up, the Overall Survival (OS), Disease-Free Survival (DFS), Local Control (LC), and Distant Metastasis-Free Survival (DMFS) at 2-, 3-, and 5-years were 94.2 %, 89.4 %, and 86.7 %, 77.5 %, 76.4 % and 64 %, 92.4 %, 90.8 % and 84 %, 77.4 %, 76.3 % and 66.6 %, respectively. Advanced T stage (HR = 4.99, p = 0.002 and HR = 4.76, p = 0.022), and solid histologic subtype (HR = 3.27, p = 0.004 and HR = 3.76, p = 0.002) negatively impacted DFS and DMFS after confounders adjustment at multivariable analysis. As for DFS, at univariable analysis, surgical margins R0/R1 positively influenced the LC in comparison to the unresected patients (p = 0.042), while HR was similar for R2 and unresected patients (p = 0.8). The maximum toxicity grade recorded was G3, 11 acute and 9 late. No G3 brain radionecrosis were registered.

Conclusions

PT was effective for ACC in our hands, with a limited toxicity burden. Identification of prognostic factors is essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.