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

Overview

Journal Acta Oncol

Date 2025 Jan 15

PMID 39813173

Authors

Eivind Storaas

Marta D Switlyk

Sigrun Dahl

Cecilie D Amdal

Ase Bratland

Thuy-Tien M Huynh

Hanne A Eide

Barbara Vischioni

Ester Orlandi

Einar Dale

Affiliations

Soon will be listed here.

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.

References

Ikawa H, Koto M, Demizu Y, Saitoh J, Suefuji H, Okimoto T . Multicenter study of carbon-ion radiation therapy for nonsquamous cell carcinomas of the oral cavity. Cancer Med. 2019; 8(12):5482-5491. PMC: 6745861. DOI: 10.1002/cam4.2408. View

Koto M, Hasegawa A, Takagi R, Ikawa H, Naganawa K, Mizoe J . Evaluation of the safety and efficacy of carbon ion radiotherapy for locally advanced adenoid cystic carcinoma of the tongue base. Head Neck. 2016; 38 Suppl 1:E2122-6. DOI: 10.1002/hed.24397. View

Vischioni B, Russo S, Meuli M, Bonora M, Ronchi S, Ingargiola R . Dosimetric and Clinical Risk Factors for the Development of Maxillary Osteoradionecrosis in Adenoid Cystic Carcinoma (ACC) Patients Treated With Carbon Ion Radiotherapy. Front Oncol. 2022; 12:829502. PMC: 8924362. DOI: 10.3389/fonc.2022.829502. View

Chieng C, Davies A, Aziz A, Lowe D, Rogers S . Health related quality of life and patient concerns in patients with osteoradionecrosis. Br J Oral Maxillofac Surg. 2021; 59(9):1061-1066. DOI: 10.1016/j.bjoms.2021.02.011. View

Kamada T, Tsujii H, Blakely E, Debus J, De Neve W, Durante M . Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical experience. Lancet Oncol. 2015; 16(2):e93-e100. DOI: 10.1016/S1470-2045(14)70412-7. View

. Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison. Radiother Oncol. 2017; 124(2):232-239. PMC: 5572506. DOI: 10.1016/j.radonc.2017.06.026. View

Katz A, Kang J . Stereotactic body radiotherapy with or without external beam radiation as treatment for organ confined high-risk prostate carcinoma: a six year study. Radiat Oncol. 2014; 9:1. PMC: 3901326. DOI: 10.1186/1748-717X-9-1. View

Koto M, Demizu Y, Saitoh J, Suefuji H, Tsuji H, Okimoto T . Definitive Carbon-Ion Radiation Therapy for Locally Advanced Sinonasal Malignant Tumors: Subgroup Analysis of a Multicenter Study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS). Int J Radiat Oncol Biol Phys. 2018; 102(2):353-361. DOI: 10.1016/j.ijrobp.2018.05.074. View

Musha A, Kubo N, Kawamura H, Okano N, Sato H, Okada K . Carbon-ion Radiotherapy for Inoperable Head and Neck Bone and Soft-tissue Sarcoma: Prospective Observational Study. Anticancer Res. 2022; 42(3):1439-1446. DOI: 10.21873/anticanres.15614. View

Locati L, Ferrarotto R, Licitra L, Benazzo M, Preda L, Farina D . Current management and future challenges in salivary glands cancer. Front Oncol. 2023; 13:1264287. PMC: 10546333. DOI: 10.3389/fonc.2023.1264287. View

10.

Kubota H, Miyawaki D, Mukumoto N, Ishihara T, Matsumura M, Hasegawa T . Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat Oncol. 2021; 16(1):1. PMC: 7786900. DOI: 10.1186/s13014-020-01701-5. View

11.

Sulaiman N, Demizu Y, Koto M, Saitoh J, Suefuji H, Tsuji H . Multicenter Study of Carbon-Ion Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck: Subanalysis of the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) Study (1402 HN). Int J Radiat Oncol Biol Phys. 2018; 100(3):639-646. DOI: 10.1016/j.ijrobp.2017.11.010. View

12.

Loap P, Vischioni B, Bonora M, Ingargiola R, Ronchi S, Vitolo V . Biological Rationale and Clinical Evidence of Carbon Ion Radiation Therapy for Adenoid Cystic Carcinoma: A Narrative Review. Front Oncol. 2021; 11:789079. PMC: 8668942. DOI: 10.3389/fonc.2021.789079. View

13.

Mendenhall W, Morris C, Amdur R, Werning J, Hinerman R, Villaret D . Radiotherapy alone or combined with surgery for adenoid cystic carcinoma of the head and neck. Head Neck. 2004; 26(2):154-62. DOI: 10.1002/hed.10380. View

14.

Studer G, Bredell M, Studer S, Huber G, Glanzmann C . Risk profile for osteoradionecrosis of the mandible in the IMRT era. Strahlenther Onkol. 2015; 192(1):32-9. PMC: 4705130. DOI: 10.1007/s00066-015-0875-6. View

15.

Jones A, Hamilton J, Rowley H, Husband D, Helliwell T . Adenoid cystic carcinoma of the head and neck. Clin Otolaryngol Allied Sci. 1998; 22(5):434-43. DOI: 10.1046/j.1365-2273.1997.00041.x. View

16.

Even C, Baste N, Classe M . New approaches in salivary gland carcinoma. Curr Opin Oncol. 2019; 31(3):169-174. DOI: 10.1097/CCO.0000000000000527. View

17.

Rogers S, DSouza J, Lowe D, Kanatas A . Longitudinal evaluation of health-related quality of life after osteoradionecrosis of the mandible. Br J Oral Maxillofac Surg. 2015; 53(9):854-7. DOI: 10.1016/j.bjoms.2015.07.008. View

18.

Naganawa K, Koto M, Takagi R, Hasegawa A, Ikawa H, Shimozato K . Long-term outcomes after carbon-ion radiotherapy for oral mucosal malignant melanoma. J Radiat Res. 2016; 58(4):517-522. PMC: 5570020. DOI: 10.1093/jrr/rrw117. View

19.

Lopes M, Kowalski L, da Cunha Santos G, Paes de Almeida O . A clinicopathologic study of 196 intraoral minor salivary gland tumours. J Oral Pathol Med. 1999; 28(6):264-7. DOI: 10.1111/j.1600-0714.1999.tb02036.x. View