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1、UnitTwentyFiveADENOIDCYSTICCARCINOMAOFTHESA;IVARYGLANDSustainedCompleteResponsetoChemotherapy.G.THOMASBUDD.MD.AND.C.W.GROPPE.MDApatientdevelopedwidelymetastaticadenoidcysticcarcinomaoftheparotidelandafterseverallocalrecurrences.Acompleteregressionofpleural,pulmonaryparenchymal,cutaneous,andbonemetas

2、taseswasseenfollowingtherapywith5-fluorouracil,Adriainycin,andmitomycinC.Thisisthesecondcompleteresponsetochemotherapyreportedforapatientwithmetastaticadenoidcysticcarcinomaofsalivaiyglandorigin.BothcompleteresponsesandseveralpartialresponseshavefollowedireatmeniwithAdriamycin,suggesting(hatthisdrug

3、isactiveinthedisease.Cancer51:589-590,1983ADENOIDCYSTICCARCINOMAhasbeenanuncommon,slowgrowingtumorcharacterizedbymultiplerecurrences.Althoughthishistologicentityisoccasionallyrepresentedintumorsoftheskin,breastandcervix,aswellastumorsarisingfromlacrimalglandsand(heceruminousglandsoftheexternalaudito

4、rycanal,adenoidcysticcarcinomamostfrequentlyoriginatesinamajororminorsalivarygland.Thistumorwasfoundin10%ofpatientspresentingwithsalivaryneoplasmstoMemorialSloan-KetteringCancerCenterandin25%ofpatientspresentingtoM.D.AndersonHospitalwithneoplasmsofthemajorsalivaryglands(parotid,submaxillary,andsubli

5、ngual),accountingfor5.2%ofallheadandneckcancers.Biologically,adenoidcysticcarcinomaischaracterizedbyslowgrowthwithinsidiousinvolvementoflocalstructures.Perineuralinvasionistypicalwhenthetumorislocatedinproximitytonervoustissue,andinfiltrativegrowthistherule.Clinically,thesecharacteristicsarcmanifest

6、asatendencyforlocalrecurrenceinapproximatelytwothirdsofpatients.Althoughdirectextensioncaninvolvelymphnodes,lymphaticspreadtoregionalnodesisnotcommon,occurringinonly15%ofthepatients.Distantmetastasesontheotherhand,occurin42-58%ofthepatients.Thelungsarefavoredsitesformetastases,althoughbone,liver,cen

7、tralnervoussystem,andotherorgansmaybecomeinvolved.Whilerelativelylongsurvivalcanoccurinthefaceofmetastaticdisease,effectivesystemictherapywouldbedesirableinviewofthetendencyforpatientswithadenoidcysticcarcinomatodevelopdistantmetastases.Theauthorsreportacompleteremissionfollowingtreatmentwith5-fluor

8、ouracil.Adriamycin(doxorubicin),andmitomycinC,inapatientwithwidelymetastaticadenoidcysticcarcinomaoftheparotidgland.CaseReportInOctober1980,a29-year-oldwhitewomanwasreferredtotheClevelandClinicformetastaticadenoidcysticcarcinomaoriginatingintheleftparotidgland.Thepatienthadundergoneresectionofaleftp

9、arotidtumorinSeptember1967foranadenoidcysticcarcinomashowinghistologicevidenceofearlyperineuralinvasion.AlocalrecurrenceinJanuary1972wastreatedbysurgicalresection.SubsequentlocalrecurrencesweretreatedbysubtotalparotidectomyinJanuary1976,andexcisioninJanuary1977,witharesectionofrecurrent(umorandaninv

10、olvednodeinJanuary1978necessitatingsacrificeoftheleftfacialnerve.AlocalrecurrenceinOctober1978wastreatedwith300()radofmegavoltageradiationdeliveredbylinearacceleratoraswellas2000radoforthovoltageradiation.ThepatientfirstnotedchestpaininJuly1980,whichwasfollowedbythedevelopmentofdyspneaonexertionanda

11、drycoughinSeptember1980.Aright-sidedpleuraleffusionwasnotedandadecubituschestx-rayrevealedtwonodulardensitiesintherightmid-lungfields.Thoracentesiswasperformedandthefluidwasfoundtocontainmalignantcellscylologicallyconsistentwithmetastaticadenoidcysticcarcinoma.Abonescanshowedincreaseduptakeoverthepu

12、bis.LI,T5andtherightribs;aliverspleenscanwasnormal.Serumchemistriesrevealedanelevationofthealkalinephosphataseto339U/L.Abiopsyspecimenofacutaneousnodulelocatedonthepatientsabdomenrevealedmetastaticcarcinoma.OnOctober17,1980,thepatientreceivedherfirstcourseofcombinationchemotherapywithFAM.Treatmentwa

13、swith5-fluorouracil500mg/ni2andAdriamycin30mg/m2intravenouslyeveryfourweeks.MitomycinCwasgivenonthefirstdayandeveryeightweeksatadosageof10nig/m2.ByFebruary26,1981,examinationofthepatientschestx-rayshowedimprovementandtheserumalkalinephosphatasehadfallento118U/L.AbonescanperformedJune25,1981wasnormal

14、.OnJuly2,1981,thepatientschestXJraywasclearherserumalkalinephosphatasewasnormalat52U/L,andphysicalexaminationrevealednoevidenceofdisease.SheremainedincompleteremissionwhenseenonOctober30,1981.WhilestillreceivingtherapywithFAM,thepatientleadsaphysicallyactivelifeandremainsdiseasefreeafter12monthsoftr

15、eatment.DiscussionThisisthesecondreportedcaseofacompleteremissionofmetastaticadenoidcysticcarcinomaofthesalivaryglandinducedbychemotherapy.Theotherreportedcompleteresponseoccurredfollowingtherapywithvincristine,intravenouscyclophosphamide,andAdriamycin.inthatcase,disease13rogressionhadoccurredduring

16、treatmentwithvincristineandoralcyclophosphamide,suggestingthatAdriamycinwastheagentresponsiblefortheinductionofremission.PartialresponseshavebeenreportedfollowingtherapywithAdriamycinandtherelatedanthracyclinedaunomycin.OffivepatientswithadvancedcarcinomaoftheparotidglandtreatedwithAdtiamycin,cispla

17、tinandcyclophosphamide,twocompleteandthreepartialresponseswerereported,althoughnoneofthesepatienttumorsdemonstratedadenoidcystichistology.Asinglepartialresponsetohexamethylmelaniinetherapyhasbeenreported,althoughclassicalalkylatingagentshavenotbeeneffective.5-Fluorouracilhasbeenshowntohavesomeactivi

18、tyagainstadenoidcysticcarcinomawhengiveneigberintra-arteriallyorintravenously.Althoughthedifficultiesinherenlintheretrospectiveassessmentofthebenefitsoftherapyinthisuncommonandslowgrowingtumorsystemhavebeenpointedout,objectiveresponsescanbedocumented.Inourpatient,aclear-cutimprovementinperformancest

19、atusandlifestylehasaccompaniedamarkedimprovementinobjectivemeasuresofdisease,andaprolongationofsurvivalmightbepresumed.Adriamycinwouldseemtobethemosteffectiveagentforthetreatmentofmetastaticadenoidcysticcarcinomaofthesalivaryglands,although5-fluorouracilhasalsoshownsomeactivity.Becausethetumorisunco

20、mmon,anyprospectivestudywouldbebatdonebyacooperativegroup,andshouldrecognizetheefficacyofAdriamycin,andperhaps5-fluorouracilinthetreatmentofthedisease.VOCABULARY1. histologicentitycervix2. perineuralinvasionlymphaticspread3. 5-flaorouraciladriamycin4. mitomycinmegavoltage5. linearacceleratordyspnea6

21、. thoracentesisvincristine7. daunomycincisplatin8. clear-cutperformancestate9. metastaticadenoidcysticcarcinoma10. lacrimalglandsceruminousglands11. parotidectomydecubitus12. anthracyclinecyclophosphamide組織學本質(zhì)子宮頸神經(jīng)周擴散淋巴道擴散5一氟尿嗜啜阿霉素絲裂霉素巨電壓直線加速器呼吸困難胸腔穿刺術(shù)長春新堿正定霉素順鉗明確的生活自理能力轉(zhuǎn)移的，遷移的腺樣囊性癌淚腺盯耳寧腺腮腺切除臥位芯環(huán)類抗生素環(huán)磷酰胺六甲蜜胺13. hexamethylmelarnine