title: Raster-scanned carbon ion therapy for malignant salivary gland tumors: acute toxicity and initial treatment response.
abstract: OBJECTIVE
  To investigate toxicity and efficacy in high-risk malignant salivary gland tumors (MSGT) of the head and neck. Local control in R2-resected adenoid cystic carcinoma was already improved with a combination of IMRT and carbon ion boost at only mild side-effects, hence this treatment was also offered to patients with MSGT and microscopic residual disease (R1) or perineural spread (Pn+).
  
  
  METHODS
  From November 2009, all patients with MSGT treated with carbon ion therapy were evaluated. Acute side effects were scored according to CTCAE v.4.03. Tumor response was assessed according to RECIST where applicable.
  
  
  RESULTS
  103 patients were treated from 11/2009 to 03/2011, median follow-up is 6 months. 60 pts received treatment following R2 resections or as definitive radiation, 43 patients received adjuvant radiation for R1 and/or Pn+. 16 patients received carbon ion treatment for re-irradiation. Median total dose was 73.2 GyE (23.9 GyE carbon ions + 49,9 Gy IMRT) for primary treatment and 44.9 GyE carbon ions for re-irradiation. All treatments were completed as planned and generally well tolerated with no > CTC°III toxicity. Rates of CTC°III toxicity (mucositis and dysphagia) were 8.7% with side-effects almost completely resolved at first follow-up.47 patients showed good treatment responses (CR/PR) according to RECIST.
  
  
  CONCLUSIONS
  Acute toxicity remains low in IMRT with carbon ion boost also in R1-resected patients and patients undergoing re-irradiation. R2-resected patients showed high rates of treatment response, though follow-up is too short to assess long-term disease control.
authors: Dept. Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany. Alexandra.Jensen@med.uni-heidelberg.de
authors: Alexandra D
authors: AD
authors: Jensen
authors: Anna V
authors: AV
authors: Nikoghosyan
authors: Swantje
authors: S
authors: Ecker
authors: Malte
authors: M
authors: Ellerbrock
authors: Jürgen
authors: J
authors: Debus
authors: Klaus K
authors: KK
authors: Herfarth
authors: Marc W
authors: MW
authors: Münter
mesh_terms: D002244:Carbon / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D007477:Ions / Q000627:therapeutic use*; D009362:Neoplasm Metastasis; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012306:Risk; D012468:Salivary Gland Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D007477:Ions; D002244:Carbon