The role of fast neutron radiation therapy in the management of advanced salivary gland malignant neoplasms.
Fifty-three patients with locally advanced salivary gland malignant neoplasm were treated with fast neutron radiation therapy. All patients received treatment for gross inoperable, residual unresectable, or recurrent disease--clinical situations in which results using photon irradiation were suboptimal. With a median follow-up of 42 months and a minimum follow-up of 1 year, locoregional tumor control in the treatment field was achieved in 92% (48 of 52) of patients. An additional eight patients had regional failures outside the treatment field, resulting in an overall locoregional tumor control rate of 77% (40 of 52). The 5-year actuarial locoregional control rates were 65% overall and 75% in patients with node-positive disease. Grouping patients according to prior treatment status, actuarial 5-year locoregional control rates were 92% for patients treated definitively (without a prior surgical procedure), 63% for those treated postoperatively for gross residual disease, and 51% for those treated for recurrent disease after a surgical procedure. The P values associated with these differences were 0.12 and 0.01, respectively. There were no instances of radiation-induced facial nerve damage. This study suggests that neutron irradiation alone should be the therapy of choice in the treatment of advanced-stage salivary gland tumors and that surgery should be limited to those patients in whom disease-free margins can be obtained. The potential morbidity of a debulking surgical procedure before neutron irradiation is not warranted by an improvement in loco-regional control over that achievable with neutron therapy alone.
Buchholz
T A
TA
Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195.
Laramore
G E
GE
Griffin
B R
BR
Koh
W J
WJ
Griffin
T W
TW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005214:Fast Neutrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012468:Salivary Gland Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016019:Survival Analysis