Biological Rationale and Clinical Evidence of Carbon Ion Radiation Therapy for Adenoid Cystic Carcinoma: A Narrative Review

Loap, Pierre; Vischioni, Barbara; Bonora, Maria; Ingargiola, Rossana; Ronchi, Sara; Vitolo, Viviana; Barcellini, Amelia; Goanta, Lucia; Marzi, Ludovic De; Dendale, R.; Pacelli, Roberto; Locati, Laura D.; Calugaru, Valentin; Mammar, Hamid; Cavalieri, Stefano; Kirova, Youlia; Orlandi, Ester

doi:10.3389/fonc.2021.789079

Cited by 16 publications

(16 citation statements)

References 106 publications

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“…Several studies using IMRT showed an improvement in local control rates and acceptable toxicities [39][40][41]. Due to the radioresistance of ACC and prognosis improvement after a higher RT dose (≥ 60 Gy) [21,42], RT techniques using high linear energy transfer particles have been also evaluated. Charged particle beams such as proton therapy and carbon ion radiotherapy are characterized by a Bragg peak that enables delivery of larger doses of radiation to the tumor while significantly lowering the dose to the surrounding healthy tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Charged particle beams such as proton therapy and carbon ion radiotherapy are characterized by a Bragg peak that enables delivery of larger doses of radiation to the tumor while significantly lowering the dose to the surrounding healthy tissues. Recently, carbon-ion radiotherapy is increasingly used for ACC irradiation, based on immunological, molecular, and clinicopathological rationale [42]. Carbon-ion radiotherapy has shown excellent local control rates in the adjuvant setting as well as in the definitive setting, without an increase in grade ≥ 3 toxicities [42][43][44].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, carbon-ion radiotherapy is increasingly used for ACC irradiation, based on immunological, molecular, and clinicopathological rationale [42]. Carbon-ion radiotherapy has shown excellent local control rates in the adjuvant setting as well as in the definitive setting, without an increase in grade ≥ 3 toxicities [42][43][44]. Although we could not demonstrate the effectiveness of heavy-ion therapy in this study, we showed that the RT technique (IMRT) was an independent significant prognostic factor for LRFFS.…”

Section: Discussionmentioning

confidence: 99%

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Role of postoperative radiotherapy in resected adenoid cystic carcinoma of the head and neck

et al. 2022

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Purpose Although postoperative radiotherapy (PORT) is demonstrably effective in local control of head and neck adenoid cystic carcinoma (HNACC), its application is controversial and the subset of patients who would benefit most from PORT is unknown. Herein, we analyzed the data of HNACC patients to clarify the role of PORT. Methods We retrospectively reviewed 187 patients with nonmetastatic HNACC who underwent surgical resection between 2005 and 2019. The study endpoints were locoregional failure-free survival (LRFFS), progression-free survival (PFS), and overall survival (OS). Subgroup analysis and recursive partitioning analysis (RPA) were performed to identify patients most likely to benefit from PORT. Results With a median follow-up of 84.7 months, the 5-year LRFFS, PFS, and OS were 70.0%, 52.6%, and 86.4%, respectively. Survival was significantly shorter in patients who experienced local failure than in those who did not (5-year OS: 88.1% vs. 80.5%, P = 0.001). The local failure rate was significantly lower in patients who underwent PORT (16.9% vs. 31.0%, P = 0.021), despite the high frequency of adverse factors. Especially, significant decreases in local failure and similar OS rates could be obtained after PORT among patients with positive margins, T2-4 stage disease, and minor salivary gland tumors. The RPA model for PFS categorized patients into four groups according to three prognostic factors (T-stage, location, and sex). The RPA model for LRFFS and OS suggested three groups based on two factors (T-stage, margin for LRFFS; T-stage, grade 3 for OS). Conclusion PORT could prevent dismal survival, while significantly reducing local failures in high-risk HNACC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Role of postoperative radiotherapy in resected adenoid cystic carcinoma of the head and neck

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“…However, a larger cohort of similarly treated patients and a longer follow-up are needed to validate the efficacy of this treatment option [ 1 , 22 ]. A review by Loap et al nicely summarized that carbon ion radiation therapy (CIRT) can achieve substantial tumor control, explaining why CIRT is becoming an increasingly applied irradiation modality for ACC in light of its intrinsic radioresistance [ 1 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Adenoid Cystic Carcinoma of Bartholin’s Gland: A Case Report with Emphasis on Surgical Management

2022

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Patient: Female, 42-year-old Final Diagnosis: Adenoid cystic carcinoma of the Bartholin’s gland Symptoms: Dispareunia • foreign body sensation in the vagina • palpable mass in the vagina • vaginal pain Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Adenoid cystic carcinomas of Bartholin’s gland are rare among gynecological malignancies, accounting for 0.1% to 7% of vulvar carcinomas and 0.001% of all female genital tract malignancies. There are no specific guidelines regarding treatment recommendations; therefore, they are commonly treated like vulvar cancer. Case Report: We present the case of a 42-year-old premenopausal woman with an adenoid cystic carcinoma of Bartholin’s gland diagnosed upon biopsy of a palpable, predominantly vaginally located mass causing foreign-body sensation, vaginal pain, and extreme dyspareunia. The adenoid cystic carcinoma of Bartholin’s gland was treated by radical resection in an extensive interdisciplinary surgical approach including bilateral inguinal lymph node dissection, partial posterior colpectomy, amputation of the rectum, and creation of a descendostomy, as well as reconstruction of the vagina and defect coverage using flap plastic. Conclusions: With the presentation of this case, we propose a possible therapeutic approach to adenoid cystic carcinomas of Bartholin’s gland with emphasis on surgical management. Especially in young patients, we recommend primary radical surgery with the objective to obtain negative resection margins. However, additional data on the adenoid cystic carcinoma of Bartholin’s gland is needed to better understand its biological behavior and thus optimize and standardize treatment. The role of systematic inguinal-femoral lymphadenectomy and adjuvant and neoadjuvant treatment modalities need further evaluation.

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“…The gold standard treatment for ACC is radical surgical resection followed by post-operative RT ( 7 ). In case of unresectable locally advanced tumors or with tumor macroscopic persistence after surgical resection or patient contraindication to surgery ( 8 – 10 ), or reirradiation ( 11 ), CIRT has been recently shown to have higher efficacy compared to conventional photon RT ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric and Clinical Risk Factors for the Development of Maxillary Osteoradionecrosis in Adenoid Cystic Carcinoma (ACC) Patients Treated With Carbon Ion Radiotherapy

et al. 2022

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BackgroundThe present study aims to evaluate dosimetric and clinical risk factors for the development of maxillary osteoradionecrosis (ORN) in head and neck adenoid cystic carcinoma (ACC) patients treated with carbon ion radiotherapy (CIRT).MethodsClinical data and treatment plans of ACC patients, consecutively treated from January 2013 to September 2016 within the phase II clinical trial CNAO S9/2012/C, were retrospectively reviewed. ORN and other treatment-related toxicity were graded according to the Common Terminology Criteria for Adverse Events (CTACE), version 4.0. The maxillary bone was contoured on the planning CT, and only patients receiving more than 10% of the prescription dose at their maxilla were considered for the analysis (67 patients). The volumes of maxilla receiving doses from 10 Gy (RBE) to 60 Gy (RBE) (VD), with an increment of 10 Gy (RBE), and additional clinical factors were correlated to the incidence of ORN with univariate analysis (Chi-square test). The logistic regression model was subsequently applied for multivariate analysis. Treatment plans calculated with a local effect model (LEM)-based optimization were recalculated with the modified microdosimetric kinetic model (MKM), and compared with literature data from the Japanese experience.ResultsThe median time interval from the start of CIRT to ORN appearance was 24 months (range, 8–54 months). Maxillary ORN was observed in 11 patients (16.4%). Grade 1 ORN was observed in 2 patients (18.1%), G2 in 4 (36.3%), G3 in 4 (36.3%) and G4 in 1 (9.3%). From univariate analysis, the site of the tumor, the presence of teeth within the PTV and acute mucositis correlated with the development of maxillary ORN. VD were significantly higher for all the dose levels tested in patients with maxillary ORN than patients without necrosis, according to both radiobiological models. The multivariate analysis showed that V60 significantly correlated with ORN risk.ConclusionThe volume of maxilla irradiated with high dose values was relevant for ORN development in our cohort of ACC patients. These results are in line with previously published data obtained with a different radiobiological model. Our findings might be helpful to prevent the risk of ORN in patients receiving CIRT.

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Biological Rationale and Clinical Evidence of Carbon Ion Radiation Therapy for Adenoid Cystic Carcinoma: A Narrative Review

Cited by 16 publications

References 106 publications

Role of postoperative radiotherapy in resected adenoid cystic carcinoma of the head and neck

Role of postoperative radiotherapy in resected adenoid cystic carcinoma of the head and neck

Adenoid Cystic Carcinoma of Bartholin’s Gland: A Case Report with Emphasis on Surgical Management

Dosimetric and Clinical Risk Factors for the Development of Maxillary Osteoradionecrosis in Adenoid Cystic Carcinoma (ACC) Patients Treated With Carbon Ion Radiotherapy

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