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1、UnitTwentyFive
ADENOIDCYSTICCARCINOMAOFTHESA;IVARYGLAND
SustainedCompleteResponsetoChemotherapy.
G.THOMASBUDD.MD.AND.C.W.GROPPE.MD
Apatientdevelopedwidelymetastaticadenoidcysticcarcinomaoftheparotidelandafterseverallocalrecurrences.Acompleteregressionofpleural,pulmonaryparenchymal,cutaneous,andb
2、onemetastaseswasseenfollowingtherapywith5-fluorouracil,Adriainycin,andmitomycinC.Thisisthesecondcompleteresponsetochemotherapyreportedforapatientwithmetastaticadenoidcysticcarcinomaofsalivaiyglandorigin.BothcompleteresponsesandseveralpartialresponseshavefollowedireatmeniwithAdriamycin,suggesting(hat
3、thisdrugisactiveinthedisease.
Cancer51:589-590,1983
ADENOIDCYSTICCARCINOMAhasbeenanuncommon,slowgrowingtumorcharacterizedbymultiplerecurrences.Althoughthishistologicentityisoccasionallyrepresentedintumorsoftheskin,breastandcervix,aswellastumorsarisingfromlacrimalglandsand(heceruminousglandsoftheex
4、ternalauditorycanal,adenoidcysticcarcinomamostfrequentlyoriginatesinamajororminorsalivarygland.Thistumorwasfoundin10%ofpatientspresentingwithsalivaryneoplasmstoMemorialSloan-KetteringCancerCenterandin25%ofpatientspresentingtoM.D.AndersonHospitalwithneoplasmsofthemajorsalivaryglands(parotid,submaxill
5、ary,andsublingual),accountingfor5.2%ofallheadandneckcancers.Biologically,adenoidcysticcarcinomaischaracterizedbyslowgrowthwithinsidiousinvolvementoflocalstructures.Perineuralinvasionistypicalwhenthetumorislocatedinproximitytonervoustissue,andinfiltrativegrowthistherule.Clinically,thesecharacteristic
6、sarcmanifestasatendencyforlocalrecurrenceinapproximatelytwothirdsofpatients.Althoughdirectextensioncaninvolvelymphnodes,lymphaticspreadtoregionalnodesisnotcommon,occurringinonly15%ofthepatients.Distantmetastasesontheotherhand,occurin42-58%ofthepatients.Thelungsarefavoredsitesformetastases,althoughbo
7、ne,liver,centralnervoussystem,andotherorgansmaybecomeinvolved.
Whilerelativelylongsurvivalcanoccurinthefaceofmetastaticdisease,effectivesystemictherapywouldbedesirableinviewofthetendencyforpatientswithadenoidcysticcarcinomatodevelopdistantmetastases.Theauthorsreportacompleteremissionfollowingtreatm
8、entwith5-fluorouracil.Adriamycin(doxorubicin),andmitomycinC,inapatientwithwidelymetastaticadenoidcysticcarcinomaoftheparotidgland.
CaseReport
InOctober1980,a29-year-oldwhitewomanwasreferredtotheClevelandClinicformetastaticadenoidcysticcarcinomaoriginatingintheleftparotidgland.Thepatienthadundergon
9、eresectionofaleftparotidtumorinSeptember1967foranadenoidcysticcarcinomashowinghistologicevidenceofearlyperineuralinvasion.AlocalrecurrenceinJanuary1972wastreatedbysurgicalresection.SubsequentlocalrecurrencesweretreatedbysubtotalparotidectomyinJanuary1976,andexcisioninJanuary1977,witharesectionofrecu
10、rrent(umorandaninvolvednodeinJanuary1978necessitatingsacrificeoftheleftfacialnerve.AlocalrecurrenceinOctober1978wastreatedwith300()radofmegavoltageradiationdeliveredbylinearacceleratoraswellas2000radoforthovoltageradiation.
ThepatientfirstnotedchestpaininJuly1980,whichwasfollowedbythedevelopmentofd
11、yspneaonexertionandadrycoughinSeptember1980.Aright-sidedpleuraleffusionwasnotedandadecubituschestx-rayrevealedtwonodulardensitiesintherightmid-lungfields.Thoracentesiswasperformedandthefluidwasfoundtocontainmalignantcellscylologicallyconsistentwithmetastaticadenoidcysticcarcinoma.Abonescanshowedincr
12、easeduptakeoverthepubis.LI,T5andtherightribs;aliverspleenscanwasnormal.Serumchemistriesrevealedanelevationofthealkalinephosphataseto339U/L.Abiopsyspecimenofacutaneousnodulelocatedonthepatient'sabdomenrevealedmetastaticcarcinoma.
OnOctober17,1980,thepatientreceivedherfirstcourseofcombinationchemothe
13、rapywithFAM.Treatmentwaswith5-fluorouracil500mg/ni2andAdriamycin30mg/m2intravenouslyeveryfourweeks.MitomycinCwasgivenonthefirstdayandeveryeightweeksatadosageof10nig/m2.ByFebruary26,1981,examinationofthepatient'schestx-rayshowedimprovementandtheserumalkalinephosphatasehadfallento118U/L.Abonescanperfo
14、rmedJune25,1981wasnormal.OnJuly2,1981,thepatient'schestXJraywasclearherserumalkalinephosphatasewasnormalat52U/L,andphysicalexaminationrevealednoevidenceofdisease.SheremainedincompleteremissionwhenseenonOctober30,1981.WhilestillreceivingtherapywithFAM,thepatientleadsaphysicallyactivelifeandremainsdis
15、easefreeafter12monthsoftreatment.
Discussion
Thisisthesecondreportedcaseofacompleteremissionofmetastaticadenoidcysticcarcinomaofthesalivaryglandinducedbychemotherapy.Theotherreportedcompleteresponseoccurredfollowingtherapywithvincristine,intravenouscyclophosphamide,andAdriamycin.inthatcase,disease
16、13rogressionhadoccurredduringtreatmentwithvincristineandoralcyclophosphamide,suggestingthatAdriamycinwastheagentresponsiblefortheinductionofremission.PartialresponseshavebeenreportedfollowingtherapywithAdriamycinandtherelatedanthracyclinedaunomycin.Offivepatientswithadvancedcarcinomaoftheparotidglan
17、dtreatedwithAdtiamycin,cisplatinandcyclophosphamide,twocompleteandthreepartialresponseswerereported,althoughnoneofthesepatienttumorsdemonstratedadenoidcystichistology.Asinglepartialresponsetohexamethylmelaniinetherapyhasbeenreported,althoughclassicalalkylatingagentshavenotbeeneffective.5-Fluorouraci
18、lhasbeenshowntohavesomeactivityagainstadenoidcysticcarcinomawhengiveneigberintra-arteriallyorintravenously.
Althoughthedifficultiesinherenlintheretrospectiveassessmentofthebenefitsoftherapyinthisuncommonandslowgrowingtumorsystemhavebeenpointedout,objectiveresponsescanbedocumented.Inourpatient,aclea
19、r-cutimprovementinperformancestatusandlifestylehasaccompaniedamarkedimprovementinobjectivemeasuresofdisease,andaprolongationofsurvivalmightbepresumed.Adriamycinwouldseemtobethemosteffectiveagentforthetreatmentofmetastaticadenoidcysticcarcinomaofthesalivaryglands,although5-fluorouracilhasalsoshownsom
20、eactivity.Becausethetumorisuncommon,anyprospectivestudywouldbebatdonebyacooperativegroup,andshouldrecognizetheefficacyofAdriamycin,andperhaps5-fluorouracilinthetreatmentofthedisease.
VOCABULARY
1. histologicentitycervix
2. perineuralinvasionlymphaticspread
3. 5-flaorouraciladriamycin
4. mitomy
21、cinmegavoltage
5. linearacceleratordyspnea
6. thoracentesisvincristine
7. daunomycincisplatin
8. clear-cutperformancestate
9. metastaticadenoidcysticcarcinoma
10. lacrimalglandsceruminousglands
11. parotidectomydecubitus
12. anthracyclinecyclophosphamide
組織學本質子宮頸
神經周擴散淋巴道擴散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長春新堿正定霉素順鉗明確的生活自理能力轉移的，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
專業(yè)英語 Unit 25教案.docx
