A patient developed widely metastatic adenoid cystic carcinoma of the parotid eland after several local recurrences. A complete regression of pleural, pulmonary parenchymal, cutaneous, and bone metastases was seen following therapy with 5-fluorouracil, Adriamycin, and mitomycin C. This is the second complete response to chemotherapy reported for a patient with metastatic adenoid cystic carcinoma of salivary gland origin. Both complete responses and several partial responses have followed treatment with Adriamycin, suggesting that this drug is active in the disease.
Cancer 51:589-590, 1983
ADENOID CYSTIC CARCINOMA has been an uncommon, slow growing tumor characterized by multiple recurrences. Although this histologic entity is occasionally represented in tumors of the skin, breast and cervix, as well as tumors arising from lacrimal glands and the ceruminous glands of the external auditory canal, adenoid cystic carcinoma most frequently originates in a major or minor salivary gland. This tumor was found in 10% of patients presenting with salivary neoplasms to Memorial Sloan -Kettering Cancer Center and in 25 % of patients presenting to M. D. Anderson Hospital with neoplasms of the major salivary glands (parotid, submaxillary, and sublingual), accounting for 5.2 % of all head and neck cancers. Biologically, adenoid cystic carcinoma is characterized by slow growth with insidious involvement of local structures. Perineural invasion is typical when the tumor is located in proximity to nervous tissue, and infiltrative growth is the rule. Clinically, these characteristics are manifest as a tendency for local recurrence in approximately two thirds of patients. Although direct extension can involve lymph nodes, lymphatic spread to regional nodes is not common, occurring in only 15 % of the patients. Distant metastases on the other hand, occur in 42 - 58% of the patients. The lungs are favored sites for metastases, although bone, liver, central nervous system, and other organs may become involved.
While relatively long survival can occur in the face of metastatic disease, effective systemic therapy would be desirable in view of the tendency for patients with adenoid cystic carcinoma to develop distant metastases. The authors report a complete remission following treatment with 5- fluorouracil. Adriamycin (doxorubicin), and mitomycin C, in a patient with widely metastatic adenoid cystic carcinoma of the parotid gland.
Case Report
In October 1980, a 29 - year - old white woman was referred to the Cleveland Clinic for metastatic adenoid cystic carcinoma originating in the left parotid gland. The patient had undergone resection of a left parotid tumor in September 1967 for an adenoid cystic carcinoma showing histologic evidence of early perineural invasion. A local recurrence in January 1972 was treated by surgical resection. Subsequent local recurrences were treated by subtotal parotidectomy in January 1976, and excision in January 1977, with a resection of recurrent tumor and an involved node in January 1978 necessitating sacrifice of the left facial nerve. A local recurrence in October 1978 was treated with 3000 rad of megavoltage radiation delivered by linear accelerator as well as 2017 rad of orthovoltage radiation.
The patient first noted chest pain in July 1980, which was followed by the development o，英语毕业论文，英语论文范文 |
