Adenoid Cystic Carcinoma of the Skull Base: Response to Radiation Therapy and Outcomes in a Retrospective Case Series

Shekhar K. Gadkaree; Anuraag S. Parikh; Alejandro I. Rodarte; Ashton Lehmann; Stacey T. Gray; Derrick T. Lin

doi:10.1055/s-0039-1696706

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2020; 81(05): 505-510
DOI: 10.1055/s-0039-1696706

Original Article

Adenoid Cystic Carcinoma of the Skull Base: Response to Radiation Therapy and Outcomes in a Retrospective Case Series

Shekhar K. Gadkaree

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

,

Anuraag S. Parikh

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

,

Alejandro I. Rodarte

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

,

Ashton Lehmann

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

,

Stacey T. Gray

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

²Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States

,

Derrick T. Lin

¹Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States

²Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States

› Author Affiliations

Abstract

Objectives The main purpose of this article is to examine a single-center cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for pathologic features, skull base invasion, overall survival, and disease-free survival, with a focus on response to proton beam radiation therapy.

Design, Setting, and Participants Single-center institutional cancer registry was used to retrospectively identify and analyze outcomes for 12 patients treated for ACC of the nasopharynx from 2000 to 2016.

Main Outcomes and Measures Primary outcomes included 5-year overall survival and locoregional control. Statistical analysis was performed using STATA 12.0 (STATACorp, College Station, Texas, United States). Spearman's rank order correlation was used for ordinal, monotonic variables with p-values <0.05 considered statistically significant. Survival analysis was performed by Kaplan–Meier method; comparison between groups was performed using log-rank test.

Results Twelve patients with ACC of the nasopharynx were included. All patients presented with advanced disease and were treated with primary radiation therapy, typically proton beam therapy. Only two underwent a surgical attempt at resection. A majority of cases had a cribriform growth pattern. The 5-year survival was 75% and rate of locoregional control rate at 5 years was 50%, comparable to other ACC cohort studies that included earlier stage tumors in various subsites that were surgically resected.

Conclusions Although ACC is traditionally noted to be radioresistant, ACC of the nasopharynx was responsive to radiotherapy in our cohort, despite advanced stage and skull base invasion. Reasons for this improved survival are unclear and suggest the need for further pathologic and genetic characterization of nasopharyngeal ACC.

Keywords

nasopharyngeal malignancy - adenoid cystic carcinoma - skull base - radiation therapy - outcomes

Full Text

References

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