Chemoradiotherapy for Adenoid Cystic Carcinoma

Haddad, Robert I.; Posner, Marshall R.; Busse, Paul M.; Norris, Charles M.; Goguen, Laura A.; Wirth, Lori J.; Blinder, Russell A.; Krane, Jeffrey F.; Tishler, Roy B.

doi:10.1097/01.coc.0000203756.36866.17

Cited by 65 publications

(13 citation statements)

References 26 publications

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“…The use of concomitant chemotherapy or immunotherapy in squamous cell carcinoma of the head and neck (SCCHN) [20,21] has led to a significant improvement not only in local control but also in overall survival. Radiochemotherapy in treatment of malignant salivary gland tumors however, has not evolved beyond the phase II-stage or retrospective analysis of very heterogeneous treatment regimen [22-24] into a treatment standard so far.…”

Section: Discussionmentioning

confidence: 99%

IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

et al. 2012

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BackgroundThe COSMIC trial is designed to evaluate toxicity in dose-escalated treatment with intensity-modulated radiotherapy (IMRT) and carbon ion boost for malignant salivary gland tumors (MSGT) of the head and neck including patients with inoperable/ incompletely resected MSGTs (R2-group) and completely resected tumors plus involved margins or perineural spread (R1-group).MethodsCOSMIC is a prospective phase II trial of IMRT (25 × 2 Gy) and carbon ion boost (8 × 3 GyE). Primary endpoint is mucositis CTC°III, secondary endpoints are local control, progression-free survival, and toxicity. Evaluation of disease response is carried out according to the Response Evaluation Criteria in Solid Tumors (RECIST); toxicity is assessed using NCI CTC v 3.0.ResultsTwenty-nine patients were recruited from 07/2010 to 04/2011, all patients have at least completed first follow-up. Sixteen patients were treated in the R2-group, 13 in the R1-group. All treatments were completed as planned and well tolerated, mucositis CTC grade III was 25% (R2) and 15.4% (R1), no dysphagia CTC grade III was observed, no feeding tubes were necessary. Side-effects rapidly resolved, only 4 patients (13.8%) reported xerostomia grade II at first follow-up. Overall response rate (complete and partial response) according to RECIST in the R2-group is 68.8% at 6–8 weeks post treatment, all patients within this group showed radiological signs of treatment response.ConclusionNo unexpected toxicity was observed, mucositis rates and other side effects do not differ between patients with visible residual tumor and macroscopically completely resected tumors. Initial treatment response is promising though longer follow-up is needed to assess local control.Trial registrationClinical trial identifier NCT 01154270

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Section: Discussionmentioning

confidence: 99%

IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

et al. 2012

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“…Unfortunately, this response is often short-lived, as it was in this patient. Due to these results, there is no standard therapy for recurrent ACC [5]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy of sorafenib, a multi-tyrosine kinase inhibitor, in an adenoid cystic carcinoma metastatic to the lung: case report and review of literature

2011

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IntroductionTreatment for squamous cell carcinoma of the head and neck has significantly improved with the addition of cetuximab, a monoclonal antibody against the epidermal growth factor receptor, to conventional cytotoxic agents. The most significant aspect of this treatment approach is the proof that head and neck cancers are suitable for targeted therapies as has been shown in other malignancies. Unfortunately, there are other rare histologic types of head and neck cancer such as adenocarcinoma and adenoid cystic carcinoma. The latter has traditionally been considered to be chemotherapy resistant and surgical resection with or without adjuvant radiation therapy has been the rule as far as treatment is concerned. The course of adenoid cystic carcinoma ranges from indolent to aggressive; however, most patients succumb to the disease as a result of distant metastases. This clinical scenario poses a challenge to oncologists. Several conventional chemotherapy regimens and novel targeted agents have been tried in this rare histologic subtype without success.Case presentationIn this case report, we present a 59-year-old Caucasian female with refractory adenoid cystic carcinoma of the maxilla metastatic to the lung that responded to sorafenib, a novel multi-tyrosine kinase inhibitor, which targets angiogenesis, Raf kinase pathway, platelet-derived growth factor Ret, and c-Kit.ConclusionThis case illustrates the possibility that this chemoresistant tumor may need the inhibition or blocking of several oncogenic pathways. Certainly, it is imperative that more studies are done in this special population trying to identify tumorigenesis mechanisms that may be upregulated in this malignancy and could be potential targets for therapeutic development.

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“…However, recent reports have shown promising results associated with chemoradiotherapy [8,9], although the role of chemotherapy in the treatment of Adenoid cystic carcinoma (ACC) has been considered limited and there have been few reports on the application of definitive chemoradiotherapy for the management of ACC.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of superselective intra-arterial infusion with concomitant radiotherapy for adenoid cystic carcinoma of the head and neck

Homma¹,

Sakashita²,

Hatakeyama³

et al. 2015

Acta Oto-Laryngologica

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CONCLUSIONS: Superselective intra-arterial cisplatin infusion with concomitant radiotherapy (RADPLAT) is considered to be one of the treatments of choice for patients with adenoid cystic carcinoma (ACC) who prefer not to undergo radical surgery. OBJECTIVE:To evaluate the efficacy of RADPLAT for patients with ACC of the head and neck. PATIENTS AND METHODS:Between 2001 and 2010, 9 patients with untreated ACC were given superselective intra-arterial infusion of cisplatin (100-120 mg/m 2 /week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and radiotherapy (65-70Gy). RESULTS:Five patients had tumors arising in the base of tongue, 2 in the maxillary sinus, and the remaining 2 in the nasopharynx. The median follow-up period was 9y7m (range 4y6m -12y5m), and the 5-year local control (LC), overall survival (OS), and disease-free survival rates were 88.9 %, 88.9%, and 55.6%, respectively. The 10-year OS rate was 57.1%, but all patients who remained alive for over 10 years are still alive with disease. Primary tumor recurrence was observed in 5 of the 9 patients, with the median time to recurrence being 6y (range 4-9 years). Five of the 9 patients had distant metastasis, and all of these 3 patients also had primary recurrence.

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Chemoradiotherapy for Adenoid Cystic Carcinoma

Abstract: Preliminary data suggest that carboplatinum/paclitaxel based CRT for ACC provides local regional control and is a potential alternative to surgery or radiotherapy for patients with locally advanced ACC. Carboplatinum/paclitaxel based CRT warrants further study.

Cited by 65 publications

References 26 publications

IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

Efficacy of sorafenib, a multi-tyrosine kinase inhibitor, in an adenoid cystic carcinoma metastatic to the lung: case report and review of literature

The efficacy of superselective intra-arterial infusion with concomitant radiotherapy for adenoid cystic carcinoma of the head and neck

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