Distinct patterns of osteoradionecrosis after photon-based radiotherapy and carbon ion radiotherapy for unresectable adenoid cystic carcinoma of the head and neck: case series from two institutions
DOI:
https://doi.org/10.2340/1651-226X.2025.42209Keywords:
Adenoid cystic carcinoma, Head and neck cancer, carbon ion radiation therapy (CIRT)Abstract
Background and purpose: To present the clinical outcomes of two series of patients treated with carbon-ion radiotherapy (CIRT) and definitive photon radiotherapy (RT) for adenoid cystic carcinoma of the head and neck (HN-ACC).
Material and methods: The first cohort of six patients was referred from Oslo University Hospital (OUS) to Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) for CIRT in 2014–2017. The second cohort included 18 patients treated with definitive photon RT at OUS in 2005–2017. The primary endpoint was an evaluation of osteoradionecrosis (ORN) in the two cohorts. The secondary endpoints were treatment efficacy by local control (LC), progression-free survival (PFS), and overall survival (OS).
Results: The tumor stage was T4 for all the patients in the CIRT group and 15 (84%) in the photon group. There were three (50%) patients with grade 3 ORN in the CIRT group compared to one (6%) with grade 3 ORN in the photon group (p = 0.05). The 5-year LC (95% CI), PFS, and OS rates in the CIRT group and the photon group were 33% (11–100) and 39% (19–76), 17% (9–100) and 23% (2–59), and 80% (52–100) and 50% (31–82), respectively.
Interpretation: Half of the patients in the CIRT cohort experienced ORN requiring surgical management during the follow-up. Patients with ACC referred for CIRT often have a worse prognosis and more advanced disease than patients treated with photons. When returning from the referring center, these patients need close follow-up often in collaboration with treating centers to manage toxicity that impacts quality of life.
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Copyright (c) 2025 Eivind Storaas, Marta D. Switlyk, Sigrun Dahl, Cecilie D. Amdal , Åse Bratland, Thuy-Tien M. Huynh, Hanne A. Eide, Barbara Vischioni, Ester Orlandi, Einar Dale
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