gms | German Medical Science

Adenoid cystic carcinoma is a rare disease, mostly located in the salivary glands of the upper digestive tract. Adenoid cystic carcinomas are characterized by a slow growth along the vessels and the nerves. Metastases in regionary lmph nodes are rare; distant metastases occure mostly in the lung or in the bones. The incidence of local recurrences following surgery alone is about 40 – 50 % 5-10 years later. Unfavourable prognostic factors are large tumours; infiltration of nerves or incomplete resections. Postoperatively usually 60 – 66 Gy are applicated in a conventional fractionation. Following incomplete resections postoperative radiotherapy can result in local control rates of more than 80% (Garden et al. 1980) improving the local control compared to only surgically treated patients (Silverman et al. 2004). Following complete R0 resection there are conflicting data whether the addition of postoperative radiotherapy improves local control ( Silverman et al. 2004; Mendenhall et al. 2004; Gurney et al. 2005). There are some data that the improvement of local control also improves overall survival for example a multivariate analysis of Mendelhall et al. 2004 and for T4 tumours the analysis of Silverman et al. 2004. Macroscopic tumours must be treated with doses of 70 Gy and more in a conventional fractionation resulting in high local control rates of selected patients (Kreitner at el. 1988). Nevertheless late toxicity of critical organs like n. opticus; spinal cord or the eyes is a problem. Therefore some groups used combinations of IMRT and neutrons or carbon ion therapy reaching local control rates of over 75% with acceptable late toxicity (Schulz-Ertner, 2002; Huber et al. 2001). Summarizing these data radiotherapy is effective in the treatment of irresectable or partly resected tumours. Postoperative radiotherapy improves local control especially following incomplete resections, advanced tumours or tumour growth along the nerves.