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
{"title":"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。","authors":"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","doi":"10.1016/j.radonc.2025.111143","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Headandneckadenoidcysticcarcinoma(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 ACCpatientstreated with curative protontherapy(PT) at our center.</p><p><strong>Methods and materials: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>PT was effective for ACC in our hands, with a limited toxicity burden. Identification ofprognosticfactorsis essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111143"},"PeriodicalIF":5.3000,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"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\",\"doi\":\"10.1016/j.radonc.2025.111143\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Headandneckadenoidcysticcarcinoma(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 ACCpatientstreated with curative protontherapy(PT) at our center.</p><p><strong>Methods and materials: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>PT was effective for ACC in our hands, with a limited toxicity burden. Identification ofprognosticfactorsis essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.</p>\",\"PeriodicalId\":21041,\"journal\":{\"name\":\"Radiotherapy and Oncology\",\"volume\":\" \",\"pages\":\"111143\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-09-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiotherapy and Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.radonc.2025.111143\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.radonc.2025.111143","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
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: Headandneckadenoidcysticcarcinoma(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 ACCpatientstreated with curative protontherapy(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 ofprognosticfactorsis essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.
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.