Modern Radiotherapy in the Treatment of Laryngeal Adenoid Cystic Carcinoma, a systematic review.
Purpose/Objective
Adenoid cystic carcinoma (ACC) is a rare malignancy of the salivary glands. The larynx is an uncommon site of disease occurrence. This site and histotype pose a particular challenge for management because of the quality of life implications of radical surgery and the radio- and chemo-resistant nature of the tumor. The aim of this systematic review is to assess the role of modern radiotherapy in the treatment of laryngeal ACC and to suggest practical guidelines for a standardized radiotherapy protocol.
Material/Methods
A multidisciplinary team consisting of radiation and medical oncologists and otorhinolaryngologists performed a systematic review on MedLine/pubmed using the terms “carcinoma adenoid cystic” and “larynx” and “radiotherapy”. The inclusion criteria were: original article, paper concerning laryngeal ACC, paper that reported on radiotherapy for laryngeal ACC. The exclusion criteria were: papers not available, editorials/review, papers not focused on ACC radiotherapy.
Results
233 papers were reviewed, 22 paper were included. All included papers were retrospective studies; 9 papers (40.9%) were 1-patient case reports. Radiotherapy was used as adjuvant therapy in 16 papers (72.7%), as definitive therapy in 2 paper (9.1%), both definitive or adjuvant radiotherapy were used in 3 papers (13.6%) and in one paper (4.5%) patient setting was adjuvant, definitive or neoadjuvant. In 15 paper (68.2%) effect of radiotherapy alone, without any concurrent chemotherapy were described, in 6 paper (27.3%) also concurrent chemotherapy was used, in one study (4.5%) the concurrent chemotherapy was not specified.
Conclusion
Based on the scientific literature, which is limited by the lack of strong evidence, a proposal for management in terms of indication and prescription of radiotherapy and chemoradiation treatment in different clinical scenarios was proposed.
