Proton Beam Therapy Combined with Intra-Arterial Infusion Chemotherapy for Stage IV Adenoid Cystic Carcinoma of the Base of the Tongue

Adenoid cystic carcinoma (ACC) is a very rare epithelial tumor of the salivary glands. Surgical resection is considered to be a standard therapy. However, the optimal treatment strategy for managing advanced cases has not yet been established. This study evaluated the efficacy and toxicity of proton beam therapy (PBT) combined with selective intra-arterial infusion chemotherapy (IAIC) using weekly cisplatin for locally advanced ACC of the base of the tongue. Between March 2009 and February 2018, 15 patients were treated. The median follow-up duration was 56 (range: 15–116) months. The 5-year local control and overall survival rates were 89% and 76%, respectively. With regard to late toxicities, grade 2 osteoradionecrosis was found in one patient and grade 5 pharyngeal necrosis was observed in one patient. Considering most cases were significantly advanced and inoperable, this therapy was effective in controlling the primary tumor, preserving function and maintaining the quality of life. Although improvements are needed to reduce adverse events, PBT in combination with IAIC can be a treatment option for locally advanced ACC of the base of the tongue.

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Proton beam therapy combined with intra-arterial infusion chemotherapy for stage Ⅳ adenoid cystic carcinoma of the base of the tongue

Toukeibu Gan ◽

10.5981/jjhnc.47.21 ◽

2021 ◽

Vol 47 (1) ◽

pp. 21-29

Author(s):

Kanako Takayama ◽

Takahiro Kato ◽

Tatsuya Nakamura ◽

Yusuke Azami ◽

Takashi Ono ◽

...

Keyword(s):

Adenoid Cystic Carcinoma ◽

Proton Beam ◽

Proton Beam Therapy ◽

Arterial Infusion ◽

Arterial Infusion Chemotherapy ◽

Infusion Chemotherapy ◽

Adenoid Cystic ◽

Base Of The Tongue

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Proton Beam Therapy Combined With Intra-arterial Infusion Chemotherapy for Locally Advanced Tongue Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1226 ◽

2012 ◽

Vol 84 (3) ◽

pp. S463

Author(s):

K. Takayama ◽

T. Nakamura ◽

A. Takada ◽

C. Makita ◽

T. Kato ◽

...

Keyword(s):

Proton Beam ◽

Tongue Cancer ◽

Locally Advanced ◽

Proton Beam Therapy ◽

Arterial Infusion ◽

Arterial Infusion Chemotherapy ◽

Infusion Chemotherapy

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Proton beam therapy combined with selective intra-arterial infusion chemotherapy for locally advanced tongue cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6086 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6086-6086

Author(s):

Kanako Takayama ◽

Tatsuya Nakamura ◽

Akinori Takada ◽

Chiyoko Makita ◽

Motohisa Suzuki ◽

...

Keyword(s):

Proton Beam ◽

Systemic Chemotherapy ◽

Tongue Cancer ◽

Locally Advanced ◽

Proton Beam Therapy ◽

Stage Iii ◽

Bone Marrow Toxicity ◽

Arterial Infusion ◽

Arterial Infusion Chemotherapy ◽

Infusion Chemotherapy

6086 Background: The standard treatment for locally advanced tongue cancer is surgery. However, the patient’s quality of life is lost. As a newly non-operative treatment, we report the efficacy and toxicity of proton beam therapy combined with selective intra-arterial infusion chemotherapy (PBT-IACT) for locally advanced tongue cancer. Methods: Between February 2009 and August 2012, 45 cases of stage III-IV(M0) squamous cell carcinoma of the tongue (28 men and 17 women) were treated by PBT-IACT at Southern TOHOKU Proton Therapy Center. Median age was 58 years (range:24-83 years), and clinical stage III/IVA/IVB were 11/32/2 respectively. In case of surgery, the patients required subtotal or total resection of the tongue. Initially, 2 courses of systemic chemotherapy and prophyractic whole neck irradiation (36Gy/20fr.) were performed. Subsequently, for gross tumor targets, PBT (33Gy/15fr.) and IACT were administered via the superficial temporal artery by continuous infusion of cisplatin with sodium thiosulphate. For PBT, 1 or 2 portals of 210 MeV proton beam were arranged in optimal angles to avoid overdosing the risk organ. Systemic chemotherapy was performed only for age of 70 years or younger. Results: The median follow-up was 27 months (range:8-48 months). Over all survival (OS), disease-free survival (DFS), and local control (LC) rates at 2 years were 88%,78%, 80%, respectively. LC of cervical lymph node metastases at 2 years was 86%. As the early toxic event, grade 3 mucositis (32/45) and blood/bone marrow toxicity (22/45) were observed. Within 6 months after this therapy, mandibular osteomyelitis occurred in 1 case. Conclusions: PBT-IACT appeared to be safe and has a good LC rate for locally advanced tongue cancer. Furthermore, it is not inferior to surgery and can be one of the new effective treatment options for locally advanced tongue cancer.

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Proton Beam Therapy in Combination with Intra-Arterial Infusion Chemotherapy for T4 Squamous Cell Carcinoma of the Maxillary Gingiva

Cancers ◽

10.3390/cancers10090333 ◽

2018 ◽

Vol 10 (9) ◽

pp. 333

Author(s):

Hiromasa Endo ◽

Kanako Takayama ◽

Kenji Mitsudo ◽

Tatsuya Nakamura ◽

Ichiro Seto ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Proton Beam ◽

Squamous Cell ◽

Proton Beam Therapy ◽

Photon Radiation ◽

Arterial Infusion ◽

Arterial Infusion Chemotherapy ◽

Infusion Chemotherapy ◽

Grade 3

This study aimed to evaluate the therapeutic effect and toxicity of proton beam therapy in combination with intra-arterial infusion chemotherapy in patients with squamous cell carcinoma of the maxillary gingiva. Between December 2010 and March 2016, 30 patients with T4 squamous cell carcinoma of the maxillary gingiva were treated with radiotherapy and retrograde intra-arterial infusion chemotherapy using cisplatin (20–40 mg/m2, 4–6 times). Radiotherapy was basically administered using boost proton beam therapy for primary tumor and neck lymph node tumors, following 36–40 Gy photon radiation therapy delivered to the prophylactic area, to a total dose of 70.4–74.8 Gy. The median follow-up was 33 months. The 3-year local control and overall survival rates were 69% and 59%, respectively. Major grade 3 or higher acute toxicities included mucositis, neutropenia, and dermatitis in 12 (40%), 5 (17%), and 3 (10%) patients, respectively. No grade 3 or higher late toxicities were observed. These results suggested that proton beam therapy in combination with intra-arterial infusion chemotherapy was not inferior to other treatment protocols and should be considered as a safe and effective option in patients with T4 squamous cell carcinoma of the maxillary gingiva.

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