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DOI: 10.1055/s-0029-1237354
© Georg Thieme Verlag KG Stuttgart · New York
Behandlungsstrategie bei sinunasalen adenoidzystischen Karzinomen – Ein Fall mit Literaturübersicht
Therapeutic Options in Sinunasal Adenoid Cystic Carcinomas – A Case Report and ReviewPublication History
Publication Date:
07 October 2009 (online)
Zusammenfassung
Hintergrund: Adenoidzystische Karzinome (ACC) im sinunasalen Bereich sind häufig nicht komplett zu resezieren. Vor diesem Hintergrund ist sowohl präoperativ über Resektionsgrenzen und funktionelle Ergebnisse zu diskutieren, als auch postoperativ über adjuvante Maßnahmen nachzudenken. Die frühere Meinung einer Strahlen- bzw. Chemoresistenz der ACC scheint überholt, obgleich kein einheitlicher Konsens über die therapeutische Strategie besteht.
Material und Methoden: Wir diskutieren die therapeutischen Optionen und vergleichen Literaturdaten bezüglich der optimalen adjuvanten Therapie an dem Fall einer 25-jährigen Patientin mit einem fortgeschrittenen adenoidzystischen Karzinom der Fossa pterygopalatina links. Daneben stellen wir alternative primäre oder adjuvante Therapieoptionen wie Neutronenbestrahlung, Chemotherapie oder „targeted” Therapie vor. Nach den Empfehlungen aus der Literatur haben wir eine augerhaltende Tumorresektion mittels transmaxilloethmoidaler Sphenoidektomie links über einen kombinierten trans- und extranasalen Zugang durchgeführt. Unter Inkaufnahme fehlender Randschnittfreiheit zugunsten des Verzichts auf verstümmelnde Maßnahmen wurde eine adjuvante Radiochemotherapie mit Taxol und Carboplatin durchgeführt.
Ergebnisse: Dadurch gelang bis dato (36 Monate postoperativ) eine optimale Lokalkontrolle bei anhaltendem uneingeschränktem Visus ohne funktionelle und kosmetische Einschränkungen. Regelmäßig durchgeführte Staginguntersuchungen ergaben bislang keinen Hinweis auf einen lokalen Tumorprogress oder Metastasen.
Schlussfolgerung: Funktionserhaltende Chirurgie und adjuvante Radio-chemotherapie auch in Kombination mit Taxol und Carboplatin ist nach unserer Ansicht eine geeignete Therapieoption zur Behandlung eines fortgeschrittenen ACC, und scheint keine Nachteile gegenüber radikalen chirurgischen Maßnahmen zu haben.
Abstract
Therapeutic Options in Sinunasal Adenoid Cystic Carcinomas – A Case Report and Review
Background: Adenoid cystic carcinomas (ACC) in sinunasal compartments are often not completely resectable. We discuss both, surgical margins and functional results preoperatively and postoperative options for adjuvant therapy. The former opinion of a resistance of ACC towards chemotherapy or irradiation seems to be outdated, even though consensus about therapeutic strategies is still missing.
Material and methods: We discuss therapeutic options and compare data from literature regarding the best adjuvant therapy with the case of a 25-year-old patient with an advanced ACC of the left fossa pterygopalatina. Further we discuss alternative therapeutic options like neutron irradiation, chemotherapy or targeted therapy. Following the advice from literature, we performed an eye saving tumor resection by a left transmaxilloethmoidale sphenoidectomy via combined trans- und extranasal approach. We accepted close surgical margins for the benefit of the abandonment of dismembering measures and performed an adjuvant radiochemotherapy with taxol and carboplatin.
Results: With the described therapeutic strategy we reached an optimal local tumor control with unlimited visus and without functional and cosmetic restrictions up to now. Periodic staging did not show any local tumor progress or metastatic spread hitherto.
Conclusion: Organ preserving surgery and adjuvant radiochemotherapy even in combination with taxol and carboplatin seems to be a sufficient therapeutic option in treating advanced sinunasal ACC, and might not have any prognostic disadvantages to radical surgery.
Schlüsselwörter
adenoidzystisches Karzinom - Fossa pterygopalatina - chirurgische Therapie - adjuvante Therapie
Key words
adenoid cystic carcinoma - fossa pterygopalatina - surgical options - adjuvant therapy
Literatur
- 1 Armstrong JG, Harrison LG, Spiro RH. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer. 1992; 69 615
- 2 Douglas JG, Laramore GE, Austin-Seymour M, Koh W, Lindley KL, Cho P, Griffin TW. Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands. Int J Radiation Oncol Biol Phys.. 1996; 36 ((3)) 87-93
- 3 Garden AS, Weber RS, Morrison WH, Ang KK, Peters LJ. The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation. Int J Radiat Oncol Biol Phys. 1995; 32 619-626
- 4 Nascimento AG, Amaral AL, Prado LA, Kligerman J, Silveira TRP. Adenoid cystic carcinoma of salivary glands: a study of 61 cases with clinicopathological correlation. Cancer. 1985; 57 312-319
- 5 Spiro RH. Salivary neoplasmas: overview of a 35-year-experience with 2807 patients. Head Neck Surg. 1986; 8 177-182
- 6 Franzen G, Nordgard S, Boysen M, Larsen PL, Halvorsen TB, Clausen OPF. DNA content in adenoid cystic carcinomas. Head Neck. 1995; 17 49-55
- 7 Khan AJ, Di Giovanni MP, Ross DA, Sasaki CT, Carter D, Son YH, Haffty BG. Adenoid cystic carcinoma: a retrospective clinical review. Int J Cancer. 2001; 96 149-158
- 8 Kokemüller H, Eckardt A, Brachvogel P, Hausamen JE. Adenoidzystische Karzinome der großen und kleinen Speicheldrüsen: Retrospektive Analyse von 74 Patienten. Mund Kiefer Gesichts Chir. 2003; 7 94-101
- 9 Luna MA, El-Nagger A, Batsakis JG, Weber RS, Garnsey LA, Goepfert H. Flow cytometric DNA content of adenoid cystic carcinoma of submandibular gland. Correlation of histologic features and prognosis. Arch Otolaryngol Head Neck Surg. 1990; 116 1291-1296
- 10 Matsuba HM, Spector GJ, Thawley SE, Simpson JR, Mauney M, Pikul FJ. Adenoid cystic salivary gland carcinoma: a histopathological review of treatment failure patterns. Cancer. 1986; 57 519-524
- 11 Bradley PJ. Adenoid cystic carcinoma of the head and neck: A review. Curr Opin Otolaryngol Head Neck Surg. 2004; 12 127-132
- 12 Norberg-Spaak L, Dardick I, Ledin T. Adenoid cystic carcinoma: Use of cell proliferation, BCL-2 expression, histologic grade, and clinical stage as predictors of clinical outcome. Head Neck. 2000; 22 489-497
- 13 Issing PR, Hemmanouil I, Wilkens L, Karstens H, Lenarz TH. Langzeitergebnisse beim adenoidzystischen Karzinom. Laryngorhinootologie. 2002; 81 98-105
- 14 Conley J, Dingman DL. Adenoid cystic carcinoma in the head and neck (Cylindroma). Arch Otolaryngol. 1974; 100 81-90
- 15 Eby LS, Baker HW. Adenoid cystic carcinoma of the head and neck. Cancer. 1972; 29 1160-1180
- 16 Cowie VJ, Pointon RCS. Adenoid cystic carcinoma of the salivary glands. Clin Radiol. 1984; 35 331-333
- 17 Miglianco L, Eschwege F, Mrandas P, Wibault P. Cervico-facial adenoid cystic carcinoma: a study of 102 cases. Influence of radiation therapy. Int J Radiat Oncol Biol Phys. 1987; 13 673-678
- 18 van der Wal JE, Becking AG, Snow GB, van der Wal I. Distant metastases of adenoid cystic carcinoma of salivary glands and the value of diagnostic examinations during follow-up. Head Neck. 2002; 24 779-784
- 19 Frankenthaler RA, Byers RM, Luna MA, Callender DL, Wolf P, Goepfert H. Predicting occult lymph node metastases in parotid cancer. Arch Otolaryngol Head Neck Surg. 1993; 119 517-520
- 20 Stewart JG, Jackson AW, Chew MK. The role of radiotherapy in the management of malignant tumors of the salivary glands. Am J Roentgenol. 1968; 102 100-108
- 21 King JJ, Fletcher GH. Malignant tumors of the major salivary glands. Radiology. 1971; 199 381-384
- 22 Chen AM, Bucci MK, Weinberg V, Garcia J, Quivey JM, Schechter NR, Phillips TL, Fu KK, Eisele DW. Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: Prognostic features of recurrence. Int J Radiation Oncology Biol Phys. 2006; 66 152-159
- 23 Kim KH, Sung MW, Chung PS, Rhees CS. Adenoid cystic carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1994; 120 721-726
- 24 Mendenhall WM, Morris CG, Amdur RJ, Werning JW, Hinerman RW, Villaret DB. Radiotherapy alone or combined with surgery for adenoid cystic carcinoma of the head and neck. Head Neck. 2004; 26 154-162
- 25 Avery CME, Moody AB, McKinna FE, Taylor J, Henk JM, Langdon JD. Combined treatment of adenoid cystic carcinoma of the salivary glands. Int J Oral Maxillofac Surg. 2000; 29 277-279
- 26 Fordice J, Kershwaw C, El-Naggar A. Adenoid cystic carcinoma of the head and neck: predictors of morbidity and mortality. Arch Otolaryngol Head Neck Surg. 1999; 125 149-152
- 27 Prokopakis EB, Snyderman CH, Hanna EY. Risk factors of local recurrens of adenoid cystic carcinoma: The role of the postoperative radiation therapy. Am J Otolaryngol. 1999; 20 281-286
- 28 Umeda M, Nishimatsu N, Yokoo S. The role of radiotherapy for patients with adenoid cystic carcinoma of the salivary gland. Oral Med Oral Surg Pathol Oral Radiol Endod. 2000; 89 724-729
-
29 Wittekind C, Meyer HJ, Bootz F.
UICC 2002 TNM-Klassifikation maligner Tumoren. 6. Auflage . Springer Verlag 2005 - 30 Haddad RI, Posner RM, Busse PM, Norris CM, Goguen LA, Wirth LJ, Blinder R, Tishler RB. Chemoradiotherapy for adenoid cystic carcinoma: preliminary results of an organ sparing approach. Am J Clin Oncol. 2006; 29 ((2)) 153-157
- 31 Goepfert H, Luna M, Lindberg RD, White AK. Malignant salivary gland tumors of the paranasal sinuses and nasal cavity. Arch Otolaryngol. 1983; 109 662-668
- 32 Snyderman CH, Prokopakis EP, Hanna E, Muller S, Johnson J. Risk factors of local recurrence of adenoid cystic carcinoma: role of postoperative radiation. Skull Base Surg. 1995; 5 2
- 33 Wakisaka S, Nonak A, Morita Y, Fukui M, Kinoshita K. Adenoid cystic carcinoma with intracranial extension. Report of three cases. Neurosurgery. 1990; 26 1060-1065
- 34 Pitman KT, Prokopakis EP, Aydogan B, Segas J, Carrau R, Snyderman CH, Janecka IP, Hanna E, Dàmica F, Johnson J. The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinunasal tract. Head Neck. 1998; 21 402-407
- 35 Spiro RH, Hugos AG, Strong EW. Adenoid cystic carcinoma: factors influencing survival. Am J Surg. 1979; 138 579-583
- 36 Chou C, Zhu G, Luo M, Xue G. Carcinoma of the minor salivary glands. Results of surgery and combined therapy. J Oral Maxillofac Surg. 1996; 54 448-4453
- 37 Simpson JR, Thawley SE, Matsuba HM. Adenoid cystic salivary carcinoma: Treatment with irradiation and surgery. Radiology. 1984; 509-512
- 38 Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA, Tjho-Heslinga RE, de Jong JM, Roodenburg JL. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck. 2004; 26 ((8)) 681-692
- 39 Cohen AN, Damrose EJ, Huang RY. Adenoid cystic carcinoma of the submandibular gland. A 35-year review. Otolaryngol Head Neck Surg. 2004; 131 994-1000
- 40 Silverman DA, Carlson TP, Khuntia D. Role of postoperative radiation therapy in adenoid cystic carcinoma of the head and neck. Laryngoscope. 2004; 114 1194-1199
- 41 Kokemüller H, Eckardt A, Brachvogel P, Hausamen JE. Adenoid cystic carcinoma of the head and neck – A 20-year experience. Int J Oral Maxillofac Surg. 2004; 33 25-31
- 42 Diaz EM, Kies MS. Chemotherapy for skull base cancers. Otolaryngol Clin North Am. 2001; 34 1079-1085
- 43 Gilbert J, Li Y, Pinto HA. Phase II trial of taxol in salivary gland malignancies (E1394). A trial of Eastern Cooperative Oncology Group. Head Neck. 2006; 28 197
- 44 Kaplan MJ, Catrell RW. Chemotherapy for salivary gland cancer. Otolaryngol Head Neck Surg. 1986; 95 165
- 45 Scramm VL, Srodes C, Myers EN. Cisplatin therapy for adenoid cystic carcinoma. Arch Otolaryngol. 1981; 107 739
- 46 Verweij J, Mulder PH, de Graeff A. Phase II study on mitoxantrone in adenoid cystic carcinomas of the head and neck. EORTC Head and Neck Cooperative Group. Ann Oncol. 1996; 7 867
- 47 Douglas JG, Laramore GE, Austin-Seymour M, Koh W, Stelzer K, Griffin TW. Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Int J Radiat Oncol Biol Phys.. 2000; 46 ((3)) 551-557
- 48 Sur RK, Donde B, Levin V, Pacella J, Kotzen J, Cooper K, Hale M. Adenoid cystic carcinoma of the salivary glands: a review of 10 years. Laryngoscope. 1997; 107 1276-1280
- 49 Stale N, Franzen G, Boysen M, Halvorsen TB. Ki-67 as a prognostic marker in adenoid cystic carcinoma assessed with the monoclonal antibody MIB1 in paraffin sections. Laryngoscope. 1997; 107 531-536
- 50 Hoffmann TK, Sonkoly E, Homey B, Scheckenbach K, Gwosdz C, Chaker A, Schirlau K, Whiteside TL. Abberant cytokine expression in serum of patients with adenoid cystic carcinoma and squamous cell carcinoma of the head and neck. Head Neck. 2007; 5 472-478
- 51 Vered M, Braunstein E, Buchner A. Immunohistochemical study in epidermal growth factor receptor in adenoid cystic carcinoma of salivary gland origin. Head Neck. 2002; 24 632-636
Korrespondenzadresse
Dr. med. Christian Mozet
Universität Leipzig
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
Liebigstraße 10–14
04103 Leipzig
Email: christian.mozet@medizin.uni-leipzig.de