gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Combination of intensity modulated radiation therapy (IMRT) and a carbon ion boost for subtotal resected or inoperable adenoid cystic carcinomas (ACC’s) of the head and neck region

Meeting Abstract

  • M. Münter - Radiation Oncology, University of Heidelberg, Heidelberg
  • V. Umathum - Radiation Oncology, University of Heidelberg, Heidelberg
  • A. Nikoghosyan - Radiation Oncology, University of Heidelberg, Heidelberg
  • A. Jensen - Radiation Oncology, University of Heidelberg, Heidelberg
  • H. Hof - Radiation Oncology, University of Heidelberg, Heidelberg
  • O. Jaekel - Radiation Oncology, University of Heidelberg, Heidelberg
  • J. Debus - Radiation Oncology, University of Heidelberg, Heidelberg

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog143

DOI: 10.3205/09ptcog143, URN: urn:nbn:de:0183-09ptcog1439

Published: September 24, 2009

© 2009 Münter et al.
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Outline

Text

Background: Adenoid cystic carcinomas (ACC’s) are rare tumors of the salivary glands in the head and neck region. Using conventional techniques of radiotherapy the treatment results are still not satisfying. The purpose of this prospective study is to assess the clinical outcome and toxicity after a combined treatment approach of IMRT and a C12 heavy ion boost for patients with an ACC.

Patients and methods: Patients (pts) with histological confirmed locally advanced ACC’s after subtotal resection or inoperable disease received therapy according to the study protocol (primary and recurrent tumors). All pts received an IMRT treatment of the PTV to a median total dose of 54 Gy, fraction dose 2 Gy. The GTV was treated by a C12 carbon ion boost with a median total dose of 18 GyE in 6 fractions of 3GyE. Therefore the pts received a median total dose of 72 GyE. The primary end point was local control (LC). Secondary end points were toxicity (according to CTCAE v 3.0) and overall survival (OS).

Results: 59 pts (25 male, 34 female) were enrolled. Median age was 52 years (range 27–74). Median follow is 44 months (Range: 0–110 months). 1 pts is lost for follow up. All patients received the 18 GyE carbon ion boost, the median IMRT dose was 54 Gy (Range: 32,4–54 Gy). 8 tumors were located in the parotid gland and the remaining 51 tumors were ACC’s of the small salivary glands (base of skull/nasopharynx: 29 pts; paranasal sinus/maxilla: 17 pts; oropharynx: 5 pts). In 15 pts a local recurrence appeared, hence the actuarial LC after 5-years is 64% (mean LC 69 months). Actuarial OS at 5 years is 73% (mean OS is 70 months). Five pts developed distant metastasis. Grade 1 and 2 late toxicity was seen in 37/59 pts (63%): xerostomia (25 pts), reduction of hearing (12 pts), paresthesia (9 pts) headaches (8 pts), dizziness (4 pts), dysphagia (1 pt). No Grade 3 or higher late toxicity was observed.

Conclusion: Combination of IMRT and carbon ion treatment for locally advanced ACC’s resulted in high overall survival rates. The local control rate could still be improved. Only moderate toxicities were generated by the treatment concept. To receive higher local control rates the carbon ion dose should be increased in this combined modality concept.