SlideShare a Scribd company logo
Dr Ajeet Kumar Gandhi
MD (AIIMS), DNB, UICCF (MSKCC,USA)
Assistant professor, Radiation oncology
Dr RMLIMS, Lucknow
Adenoid cystic carcinoma
 Adenoid cystic carcinoma (ACC) accounts for 1% of all head
and neck (HN) cancers and about 10-22% of all malignant
tumors of the major and minor salivary glands
 Management is challenging: local invasion, perineural
involvement, distant metastasis and recurrence over a
prolonged period
 Surgery is the cornerstone of management of ACC.
Adjuvant RT yields DFS advantage, role not well defined
 Chemotherapy use is limited to recurrent/metastatic tumors
with response rates of 10%-25%
 No consensus exists on the appropriate modality for the
management of these malignancies.
Materials and Methods
 Retrospective analysis of 66 patients of non-lacrimal gland ACC
of head and neck (1995-2011) treated at AIIMS, New Delhi.
 All patients evaluated in MDT
 Surgery was done primarily for all medically operable patients
 Adjuvant RT volume included tumour bed without ENI.
 Adjuvant radiation dose was 60-64 gray at 2 gray per fraction
over 6-6.5 weeks
 Concurrent cisplatin (40 mg/m2 weekly) was added in patients
with positive margin and extra-capsular extension in patients
considered eligible for this intensified approach, else a higher
dose of radiation was used in these cases
Results
 Ten patients had
clinical node-positive
disease
 11 necks sampled, 8
patients had
pathological node
positivity (14%)
Treatment Details
 57 underwent surgery, positive margin noted in 18 (31%) and PNI
in 10 (17.5%) patients.
 Adjuvant RT delivered in 54 (81.8%) patients.
 3D-CRT (25), IMRT (4) and IG-IMRT (6) patients, Rest patients 2D-
RT was used
 Median RT dose was 60 gray in 30 fractions over 6 weeks.
 Of the 18 patients with margin positive disease
 8 patients received concomitant chemotherapy (cisplatin 40
mg/m2 weekly)
 Seven patients received higher dose of radiation - 64 gray in
32 fractions over 6.5 weeks
 3 patients had re-surgical excision with negative margins
Clinical outcome
 Median follow-up: 23 months
(range: 12-211 months)
 Nineteen patients had a
recurrence:
 13 local
 4 distant (3 lung and 1 bone)
 2 had both local and distant
metastasis (lung metastasis)
 Two years and 4 years DFS rate
were 75% and 71%, respectively.
Adenoidcystic carcinoma in head and neck cancers
Adenoidcystic carcinoma in head and neck cancers
Adenoidcystic carcinoma in head and neck cancers
Review of literature
Study Prognostic factors
Chen et al (UCSF)
Int J Radiat Oncol Biol Phys
2006;66:152-9
T4 disease, perineural invasion,
omission of PORT, and major nerve
involvement
Gomez DR et al (MSKCC)
Int J Radiat Oncol Biol Phys 2008;
70:1365-72
T4 stage and gross
or clinical nerve involvement: PFS
T4 stage and lymph node involvement:
OS
Bjorndal et al (DAHANCA)
Oral Oncology 2015; 51:1138-42
Stage and margin status: OS & LRC on
MVA.
RT improves LRC
Takebayashi S et al
Acta Otolaryngol 2018; 138: 73-79
Multicentric retrospective analysis: RT
(>60 Gray) improves LRC and OS rate
Future prospects
 NOTCH1 mutations correlates with solid histology and associated
with worse outcomes
Am J Surg Pathol 2017; 41: 1473-1482
 EGFR pathway mutations and RAS mutations in SAdCC associated
with poor prognosis.
Oncotarget. 2018 Mar 30;9(24):17043-17055
Conclusion
 The current single institutional analysis demonstrated the
superiority of multi-modality management in the form of
surgery and adjuvant radiation in the management of HN
ACC
 Invasion of skull base/ICE and lymph node involvement
confers poor prognosis
 Stratification of patients in risk groups may help identify
those with greatest benefit from adjuvant RT
 Molecular profiling may guide treatments in times to come

More Related Content

What's hot

Local and regional flaps in head and neck reconstruction
Local and regional flaps in head and neck reconstructionLocal and regional flaps in head and neck reconstruction
Local and regional flaps in head and neck reconstruction
Saleh Bakry
 
Management of Oral Cavity Cancers
Management of Oral Cavity CancersManagement of Oral Cavity Cancers
Management of Oral Cavity Cancers
KUNALGUPTA294
 
oral field cancerization - Dr Sanjana Ravindra
oral field cancerization - Dr Sanjana Ravindraoral field cancerization - Dr Sanjana Ravindra
oral field cancerization - Dr Sanjana Ravindra
Dr. Sanjana Ravindra
 
Management of oral cavity cancer 23072018
Management of oral cavity cancer 23072018Management of oral cavity cancer 23072018
Management of oral cavity cancer 23072018
Varshu Goel
 
Oral precancerous lesions
Oral precancerous lesionsOral precancerous lesions
Oral precancerous lesions
Mehul Shinde
 
Field cancerization
Field cancerizationField cancerization
Field cancerization
Sharda university
 
Tumors of salivary gland
Tumors of salivary glandTumors of salivary gland
Tumors of salivary gland
azfarneyaz
 
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
Indian dental academy
 
Salivary gland Tumors
Salivary gland TumorsSalivary gland Tumors
Salivary gland Tumors
Abhinav Mutneja
 
Management of neck metastasis (1)
Management of neck metastasis (1)Management of neck metastasis (1)
Management of neck metastasis (1)
Disha Sharma
 
Radiographic Differential Diagnosis 2009
Radiographic Differential Diagnosis 2009Radiographic Differential Diagnosis 2009
Radiographic Differential Diagnosis 2009
IAU Dent
 
Maxillectomy defect browns classification
Maxillectomy defect browns classificationMaxillectomy defect browns classification
Maxillectomy defect browns classification
Jamil Kifayatullah
 
Oral medicine case(fibro-epithelial polyp)
Oral medicine case(fibro-epithelial polyp)Oral medicine case(fibro-epithelial polyp)
Oral medicine case(fibro-epithelial polyp)
waadkhayat
 
Neck dissection
Neck dissectionNeck dissection
Neck dissection
Sanjay Maharjan
 
Pre malignant lesions and conditions
Pre malignant lesions and conditionsPre malignant lesions and conditions
Pre malignant lesions and conditions
Dr. Rajat Sachdeva
 
Copy Of Oral Precancer &Cancer
Copy Of Oral Precancer &Cancer Copy Of Oral Precancer &Cancer
Copy Of Oral Precancer &Cancer
Dr.RAJEEV KASHYAP
 
Mucoepidermoid carcinoma
Mucoepidermoid carcinomaMucoepidermoid carcinoma
Mucoepidermoid carcinoma
Nehal mohamed
 
Salivary gland tumours
Salivary gland tumoursSalivary gland tumours
Salivary gland tumours
Nilesh Kucha
 
Management of secondaries neck with occult primary
Management of secondaries neck with occult primaryManagement of secondaries neck with occult primary
Management of secondaries neck with occult primary
Sujay Susikar
 
Management of salivary gland tumor
Management of salivary gland  tumorManagement of salivary gland  tumor
Management of salivary gland tumor
Shashank Bansal
 

What's hot (20)

Local and regional flaps in head and neck reconstruction
Local and regional flaps in head and neck reconstructionLocal and regional flaps in head and neck reconstruction
Local and regional flaps in head and neck reconstruction
 
Management of Oral Cavity Cancers
Management of Oral Cavity CancersManagement of Oral Cavity Cancers
Management of Oral Cavity Cancers
 
oral field cancerization - Dr Sanjana Ravindra
oral field cancerization - Dr Sanjana Ravindraoral field cancerization - Dr Sanjana Ravindra
oral field cancerization - Dr Sanjana Ravindra
 
Management of oral cavity cancer 23072018
Management of oral cavity cancer 23072018Management of oral cavity cancer 23072018
Management of oral cavity cancer 23072018
 
Oral precancerous lesions
Oral precancerous lesionsOral precancerous lesions
Oral precancerous lesions
 
Field cancerization
Field cancerizationField cancerization
Field cancerization
 
Tumors of salivary gland
Tumors of salivary glandTumors of salivary gland
Tumors of salivary gland
 
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
MUCOEPIDERMOID CARCINOMA /certified fixed orthodontic courses by Indian denta...
 
Salivary gland Tumors
Salivary gland TumorsSalivary gland Tumors
Salivary gland Tumors
 
Management of neck metastasis (1)
Management of neck metastasis (1)Management of neck metastasis (1)
Management of neck metastasis (1)
 
Radiographic Differential Diagnosis 2009
Radiographic Differential Diagnosis 2009Radiographic Differential Diagnosis 2009
Radiographic Differential Diagnosis 2009
 
Maxillectomy defect browns classification
Maxillectomy defect browns classificationMaxillectomy defect browns classification
Maxillectomy defect browns classification
 
Oral medicine case(fibro-epithelial polyp)
Oral medicine case(fibro-epithelial polyp)Oral medicine case(fibro-epithelial polyp)
Oral medicine case(fibro-epithelial polyp)
 
Neck dissection
Neck dissectionNeck dissection
Neck dissection
 
Pre malignant lesions and conditions
Pre malignant lesions and conditionsPre malignant lesions and conditions
Pre malignant lesions and conditions
 
Copy Of Oral Precancer &Cancer
Copy Of Oral Precancer &Cancer Copy Of Oral Precancer &Cancer
Copy Of Oral Precancer &Cancer
 
Mucoepidermoid carcinoma
Mucoepidermoid carcinomaMucoepidermoid carcinoma
Mucoepidermoid carcinoma
 
Salivary gland tumours
Salivary gland tumoursSalivary gland tumours
Salivary gland tumours
 
Management of secondaries neck with occult primary
Management of secondaries neck with occult primaryManagement of secondaries neck with occult primary
Management of secondaries neck with occult primary
 
Management of salivary gland tumor
Management of salivary gland  tumorManagement of salivary gland  tumor
Management of salivary gland tumor
 

Similar to Adenoidcystic carcinoma in head and neck cancers

Scca maxillary sinus bioline journal
Scca maxillary sinus bioline journalScca maxillary sinus bioline journal
Scca maxillary sinus bioline journal
Janel Enriquez
 
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
Alexander Decker
 
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
Alexander Decker
 
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
Alexander Decker
 
Rectal Cancer and Radiotherapy: What is the Clinical Implication of a Complet...
Rectal Cancer and Radiotherapy:What is the Clinical Implication of a Complet...Rectal Cancer and Radiotherapy:What is the Clinical Implication of a Complet...
Rectal Cancer and Radiotherapy: What is the Clinical Implication of a Complet...
ensteve
 
SBRT in head and neck cancer
SBRT in  head and neck cancerSBRT in  head and neck cancer
SBRT in head and neck cancer
Dr Rushi Panchal
 
Small Cell Lung Cancer
Small Cell Lung CancerSmall Cell Lung Cancer
Small Cell Lung Cancer
Ajay Sasidharan
 
Radiotherapy in renal tumors
Radiotherapy in renal tumorsRadiotherapy in renal tumors
Radiotherapy in renal tumors
Kanhu Charan
 
H.F.R.S. for Meningiomas--Final Paper
H.F.R.S. for Meningiomas--Final PaperH.F.R.S. for Meningiomas--Final Paper
H.F.R.S. for Meningiomas--Final Paper
David Brody
 
International Journal of Neurooncology & Brain Tumors
International Journal of Neurooncology & Brain TumorsInternational Journal of Neurooncology & Brain Tumors
International Journal of Neurooncology & Brain Tumors
SciRes Literature LLC. | Open Access Journals
 
Acoustic neuroma,schwannoma.neurinoma
Acoustic neuroma,schwannoma.neurinomaAcoustic neuroma,schwannoma.neurinoma
Acoustic neuroma,schwannoma.neurinoma
Khairallah Aoucar
 
Chemoradiotherapy Anal canal cancer.pptx
Chemoradiotherapy Anal canal cancer.pptxChemoradiotherapy Anal canal cancer.pptx
Chemoradiotherapy Anal canal cancer.pptx
AtulGupta369
 
Journal club
Journal clubJournal club
Journal club
shayanzafar
 
Lapatinib in Breast Cancer
Lapatinib in Breast CancerLapatinib in Breast Cancer
Lapatinib in Breast Cancer
Prof. Shad Salim Akhtar
 
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
International Journal of Science and Research (IJSR)
 
Research Discussion
Research DiscussionResearch Discussion
Research Discussion
accurayexchange
 
MOULD abstract.pdf
MOULD abstract.pdfMOULD abstract.pdf
MOULD abstract.pdf
Kanhu Charan
 
JCRT ABSTRACTS
JCRT ABSTRACTSJCRT ABSTRACTS
JCRT ABSTRACTS
Kanhu Charan
 
Hypofractionation in hnc
Hypofractionation in hncHypofractionation in hnc
Hypofractionation in hnc
Ashutosh Mukherji
 
Rectal Cancer
Rectal Cancer Rectal Cancer
Rectal Cancer
Mohamed Abdulla
 

Similar to Adenoidcystic carcinoma in head and neck cancers (20)

Scca maxillary sinus bioline journal
Scca maxillary sinus bioline journalScca maxillary sinus bioline journal
Scca maxillary sinus bioline journal
 
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...
 
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...
 
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...
 
Rectal Cancer and Radiotherapy: What is the Clinical Implication of a Complet...
Rectal Cancer and Radiotherapy:What is the Clinical Implication of a Complet...Rectal Cancer and Radiotherapy:What is the Clinical Implication of a Complet...
Rectal Cancer and Radiotherapy: What is the Clinical Implication of a Complet...
 
SBRT in head and neck cancer
SBRT in  head and neck cancerSBRT in  head and neck cancer
SBRT in head and neck cancer
 
Small Cell Lung Cancer
Small Cell Lung CancerSmall Cell Lung Cancer
Small Cell Lung Cancer
 
Radiotherapy in renal tumors
Radiotherapy in renal tumorsRadiotherapy in renal tumors
Radiotherapy in renal tumors
 
H.F.R.S. for Meningiomas--Final Paper
H.F.R.S. for Meningiomas--Final PaperH.F.R.S. for Meningiomas--Final Paper
H.F.R.S. for Meningiomas--Final Paper
 
International Journal of Neurooncology & Brain Tumors
International Journal of Neurooncology & Brain TumorsInternational Journal of Neurooncology & Brain Tumors
International Journal of Neurooncology & Brain Tumors
 
Acoustic neuroma,schwannoma.neurinoma
Acoustic neuroma,schwannoma.neurinomaAcoustic neuroma,schwannoma.neurinoma
Acoustic neuroma,schwannoma.neurinoma
 
Chemoradiotherapy Anal canal cancer.pptx
Chemoradiotherapy Anal canal cancer.pptxChemoradiotherapy Anal canal cancer.pptx
Chemoradiotherapy Anal canal cancer.pptx
 
Journal club
Journal clubJournal club
Journal club
 
Lapatinib in Breast Cancer
Lapatinib in Breast CancerLapatinib in Breast Cancer
Lapatinib in Breast Cancer
 
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
Concurrent Radiotherapy and Weekly Paclitaxel for Locally Advanced Squmous Ce...
 
Research Discussion
Research DiscussionResearch Discussion
Research Discussion
 
MOULD abstract.pdf
MOULD abstract.pdfMOULD abstract.pdf
MOULD abstract.pdf
 
JCRT ABSTRACTS
JCRT ABSTRACTSJCRT ABSTRACTS
JCRT ABSTRACTS
 
Hypofractionation in hnc
Hypofractionation in hncHypofractionation in hnc
Hypofractionation in hnc
 
Rectal Cancer
Rectal Cancer Rectal Cancer
Rectal Cancer
 

More from Ajeet Gandhi

Techniques for Inguinal/Groin Irradiation
Techniques for Inguinal/Groin IrradiationTechniques for Inguinal/Groin Irradiation
Techniques for Inguinal/Groin Irradiation
Ajeet Gandhi
 
Radiotherapy practices in GYN malignancies
Radiotherapy practices in GYN malignanciesRadiotherapy practices in GYN malignancies
Radiotherapy practices in GYN malignancies
Ajeet Gandhi
 
Final simulation protocols in GYN malignancies
Final simulation protocols in GYN malignanciesFinal simulation protocols in GYN malignancies
Final simulation protocols in GYN malignancies
Ajeet Gandhi
 
Evolution of Intracavitary brachytherapy for carcinoma of cervix
Evolution of Intracavitary brachytherapy for carcinoma of cervixEvolution of Intracavitary brachytherapy for carcinoma of cervix
Evolution of Intracavitary brachytherapy for carcinoma of cervix
Ajeet Gandhi
 
Axillary radiotherapy versus axillary surgery in breast cancer
Axillary radiotherapy versus axillary surgery in breast cancerAxillary radiotherapy versus axillary surgery in breast cancer
Axillary radiotherapy versus axillary surgery in breast cancer
Ajeet Gandhi
 
Hormonal and novel therapies in metastatic breast cancer
Hormonal and novel therapies in metastatic breast cancerHormonal and novel therapies in metastatic breast cancer
Hormonal and novel therapies in metastatic breast cancer
Ajeet Gandhi
 
Post treatment surveillance for Genitourinary Cancers
Post treatment surveillance for Genitourinary CancersPost treatment surveillance for Genitourinary Cancers
Post treatment surveillance for Genitourinary Cancers
Ajeet Gandhi
 
Incorporating data for management of breast cancer
Incorporating data for management of breast cancerIncorporating data for management of breast cancer
Incorporating data for management of breast cancer
Ajeet Gandhi
 
Breast cancer screening
Breast cancer screeningBreast cancer screening
Breast cancer screening
Ajeet Gandhi
 
Hepatobiliary brachytherapy
Hepatobiliary brachytherapyHepatobiliary brachytherapy
Hepatobiliary brachytherapy
Ajeet Gandhi
 
Panel discussion recurrent cervical cancer
Panel discussion recurrent cervical cancerPanel discussion recurrent cervical cancer
Panel discussion recurrent cervical cancer
Ajeet Gandhi
 
Basics of linear quadratic model
Basics of linear quadratic modelBasics of linear quadratic model
Basics of linear quadratic model
Ajeet Gandhi
 
Role of radiotherapy in recurrent carcinoma cervix
Role of radiotherapy in recurrent carcinoma cervixRole of radiotherapy in recurrent carcinoma cervix
Role of radiotherapy in recurrent carcinoma cervix
Ajeet Gandhi
 
Controversies in the management of rectal cancers
Controversies in the management of rectal cancersControversies in the management of rectal cancers
Controversies in the management of rectal cancers
Ajeet Gandhi
 
T4 Larynx cancer can be treated with Chemoradiotherapy
T4 Larynx cancer can be treated with ChemoradiotherapyT4 Larynx cancer can be treated with Chemoradiotherapy
T4 Larynx cancer can be treated with Chemoradiotherapy
Ajeet Gandhi
 
Advances in radiation oncology:Cancer care
Advances in radiation oncology:Cancer careAdvances in radiation oncology:Cancer care
Advances in radiation oncology:Cancer care
Ajeet Gandhi
 
Flash radiation therapy
Flash radiation therapyFlash radiation therapy
Flash radiation therapy
Ajeet Gandhi
 
Management of recurrent Glioblastoma and role of Bevacizumab
Management of recurrent Glioblastoma and role of BevacizumabManagement of recurrent Glioblastoma and role of Bevacizumab
Management of recurrent Glioblastoma and role of Bevacizumab
Ajeet Gandhi
 
Management of Anemia in cancer patients
Management of Anemia in cancer patientsManagement of Anemia in cancer patients
Management of Anemia in cancer patients
Ajeet Gandhi
 
Aspiration pneumonia in head and neck cancer patients
Aspiration pneumonia in head and neck cancer patientsAspiration pneumonia in head and neck cancer patients
Aspiration pneumonia in head and neck cancer patients
Ajeet Gandhi
 

More from Ajeet Gandhi (20)

Techniques for Inguinal/Groin Irradiation
Techniques for Inguinal/Groin IrradiationTechniques for Inguinal/Groin Irradiation
Techniques for Inguinal/Groin Irradiation
 
Radiotherapy practices in GYN malignancies
Radiotherapy practices in GYN malignanciesRadiotherapy practices in GYN malignancies
Radiotherapy practices in GYN malignancies
 
Final simulation protocols in GYN malignancies
Final simulation protocols in GYN malignanciesFinal simulation protocols in GYN malignancies
Final simulation protocols in GYN malignancies
 
Evolution of Intracavitary brachytherapy for carcinoma of cervix
Evolution of Intracavitary brachytherapy for carcinoma of cervixEvolution of Intracavitary brachytherapy for carcinoma of cervix
Evolution of Intracavitary brachytherapy for carcinoma of cervix
 
Axillary radiotherapy versus axillary surgery in breast cancer
Axillary radiotherapy versus axillary surgery in breast cancerAxillary radiotherapy versus axillary surgery in breast cancer
Axillary radiotherapy versus axillary surgery in breast cancer
 
Hormonal and novel therapies in metastatic breast cancer
Hormonal and novel therapies in metastatic breast cancerHormonal and novel therapies in metastatic breast cancer
Hormonal and novel therapies in metastatic breast cancer
 
Post treatment surveillance for Genitourinary Cancers
Post treatment surveillance for Genitourinary CancersPost treatment surveillance for Genitourinary Cancers
Post treatment surveillance for Genitourinary Cancers
 
Incorporating data for management of breast cancer
Incorporating data for management of breast cancerIncorporating data for management of breast cancer
Incorporating data for management of breast cancer
 
Breast cancer screening
Breast cancer screeningBreast cancer screening
Breast cancer screening
 
Hepatobiliary brachytherapy
Hepatobiliary brachytherapyHepatobiliary brachytherapy
Hepatobiliary brachytherapy
 
Panel discussion recurrent cervical cancer
Panel discussion recurrent cervical cancerPanel discussion recurrent cervical cancer
Panel discussion recurrent cervical cancer
 
Basics of linear quadratic model
Basics of linear quadratic modelBasics of linear quadratic model
Basics of linear quadratic model
 
Role of radiotherapy in recurrent carcinoma cervix
Role of radiotherapy in recurrent carcinoma cervixRole of radiotherapy in recurrent carcinoma cervix
Role of radiotherapy in recurrent carcinoma cervix
 
Controversies in the management of rectal cancers
Controversies in the management of rectal cancersControversies in the management of rectal cancers
Controversies in the management of rectal cancers
 
T4 Larynx cancer can be treated with Chemoradiotherapy
T4 Larynx cancer can be treated with ChemoradiotherapyT4 Larynx cancer can be treated with Chemoradiotherapy
T4 Larynx cancer can be treated with Chemoradiotherapy
 
Advances in radiation oncology:Cancer care
Advances in radiation oncology:Cancer careAdvances in radiation oncology:Cancer care
Advances in radiation oncology:Cancer care
 
Flash radiation therapy
Flash radiation therapyFlash radiation therapy
Flash radiation therapy
 
Management of recurrent Glioblastoma and role of Bevacizumab
Management of recurrent Glioblastoma and role of BevacizumabManagement of recurrent Glioblastoma and role of Bevacizumab
Management of recurrent Glioblastoma and role of Bevacizumab
 
Management of Anemia in cancer patients
Management of Anemia in cancer patientsManagement of Anemia in cancer patients
Management of Anemia in cancer patients
 
Aspiration pneumonia in head and neck cancer patients
Aspiration pneumonia in head and neck cancer patientsAspiration pneumonia in head and neck cancer patients
Aspiration pneumonia in head and neck cancer patients
 

Recently uploaded

Lymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching LecturesLymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching Lectures
MiadAlsulami
 
General Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormonesGeneral Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormones
MedicoseAcademics
 
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
Ks doctor
 
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptxPICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
Aloy Okechukwu Ugwu
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Stuart McGill
 
Kayakalp Clinic Best Sexologist of patna
Kayakalp Clinic Best Sexologist of patnaKayakalp Clinic Best Sexologist of patna
Kayakalp Clinic Best Sexologist of patna
Kayakalp Clinic - Best Sexologist In Patna
 
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdfA Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
Jim Jacob Roy
 
Endocrine Physiology - Insulin and Glucagon
Endocrine Physiology -  Insulin and GlucagonEndocrine Physiology -  Insulin and Glucagon
Endocrine Physiology - Insulin and Glucagon
MedicoseAcademics
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
MedicoseAcademics
 
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
paridubey2024#G05
 
Introduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate studentIntroduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate student
Shamsuddin Mahmud
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
Debre Berhan University
 
World Population Day 2024_Overview_Dr Bijan Das
World Population Day 2024_Overview_Dr Bijan DasWorld Population Day 2024_Overview_Dr Bijan Das
World Population Day 2024_Overview_Dr Bijan Das
srmnchatripura
 
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
hf66550
 
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
MARIALUISADELROGONZL
 
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
ailynolive
 
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
ishaguptaji14
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi
 
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
Internal medicine department, faculty of Medicine Beni-Suef University Egypt
 
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
NephroTube - Dr.Gawad
 

Recently uploaded (20)

Lymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching LecturesLymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching Lectures
 
General Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormonesGeneral Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormones
 
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
1130712-肺阻塞照護新趨勢-講師:鄭孟軒社主任-社團法人高雄市醫師公會.pdf
 
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptxPICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
 
Kayakalp Clinic Best Sexologist of patna
Kayakalp Clinic Best Sexologist of patnaKayakalp Clinic Best Sexologist of patna
Kayakalp Clinic Best Sexologist of patna
 
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdfA Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
A Quiz on Tuberculosis ( conducted as a part of World TB Day 2024 ).pdf
 
Endocrine Physiology - Insulin and Glucagon
Endocrine Physiology -  Insulin and GlucagonEndocrine Physiology -  Insulin and Glucagon
Endocrine Physiology - Insulin and Glucagon
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
 
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Bangalore @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
 
Introduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate studentIntroduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate student
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
 
World Population Day 2024_Overview_Dr Bijan Das
World Population Day 2024_Overview_Dr Bijan DasWorld Population Day 2024_Overview_Dr Bijan Das
World Population Day 2024_Overview_Dr Bijan Das
 
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
High Girls Call Ranchi 000XX00000 Provide Best And Top Girl Service And No1 i...
 
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...
 
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
Verified Girls Call Mumbai 🎈🔥9930687706 🔥💋🎈 Provide Best And Top Girl Service...
 
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
Ghaziabad @Girls @Call WhatsApp Numbers 🫦0000XX0000🫦 List For Friendship Girl...
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
 
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of...
 
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...
 

Adenoidcystic carcinoma in head and neck cancers

  • 1. Dr Ajeet Kumar Gandhi MD (AIIMS), DNB, UICCF (MSKCC,USA) Assistant professor, Radiation oncology Dr RMLIMS, Lucknow
  • 2. Adenoid cystic carcinoma  Adenoid cystic carcinoma (ACC) accounts for 1% of all head and neck (HN) cancers and about 10-22% of all malignant tumors of the major and minor salivary glands  Management is challenging: local invasion, perineural involvement, distant metastasis and recurrence over a prolonged period  Surgery is the cornerstone of management of ACC. Adjuvant RT yields DFS advantage, role not well defined  Chemotherapy use is limited to recurrent/metastatic tumors with response rates of 10%-25%  No consensus exists on the appropriate modality for the management of these malignancies.
  • 3. Materials and Methods  Retrospective analysis of 66 patients of non-lacrimal gland ACC of head and neck (1995-2011) treated at AIIMS, New Delhi.  All patients evaluated in MDT  Surgery was done primarily for all medically operable patients  Adjuvant RT volume included tumour bed without ENI.  Adjuvant radiation dose was 60-64 gray at 2 gray per fraction over 6-6.5 weeks  Concurrent cisplatin (40 mg/m2 weekly) was added in patients with positive margin and extra-capsular extension in patients considered eligible for this intensified approach, else a higher dose of radiation was used in these cases
  • 4. Results  Ten patients had clinical node-positive disease  11 necks sampled, 8 patients had pathological node positivity (14%)
  • 5. Treatment Details  57 underwent surgery, positive margin noted in 18 (31%) and PNI in 10 (17.5%) patients.  Adjuvant RT delivered in 54 (81.8%) patients.  3D-CRT (25), IMRT (4) and IG-IMRT (6) patients, Rest patients 2D- RT was used  Median RT dose was 60 gray in 30 fractions over 6 weeks.  Of the 18 patients with margin positive disease  8 patients received concomitant chemotherapy (cisplatin 40 mg/m2 weekly)  Seven patients received higher dose of radiation - 64 gray in 32 fractions over 6.5 weeks  3 patients had re-surgical excision with negative margins
  • 6. Clinical outcome  Median follow-up: 23 months (range: 12-211 months)  Nineteen patients had a recurrence:  13 local  4 distant (3 lung and 1 bone)  2 had both local and distant metastasis (lung metastasis)  Two years and 4 years DFS rate were 75% and 71%, respectively.
  • 10. Review of literature Study Prognostic factors Chen et al (UCSF) Int J Radiat Oncol Biol Phys 2006;66:152-9 T4 disease, perineural invasion, omission of PORT, and major nerve involvement Gomez DR et al (MSKCC) Int J Radiat Oncol Biol Phys 2008; 70:1365-72 T4 stage and gross or clinical nerve involvement: PFS T4 stage and lymph node involvement: OS Bjorndal et al (DAHANCA) Oral Oncology 2015; 51:1138-42 Stage and margin status: OS & LRC on MVA. RT improves LRC Takebayashi S et al Acta Otolaryngol 2018; 138: 73-79 Multicentric retrospective analysis: RT (>60 Gray) improves LRC and OS rate
  • 11. Future prospects  NOTCH1 mutations correlates with solid histology and associated with worse outcomes Am J Surg Pathol 2017; 41: 1473-1482  EGFR pathway mutations and RAS mutations in SAdCC associated with poor prognosis. Oncotarget. 2018 Mar 30;9(24):17043-17055
  • 12. Conclusion  The current single institutional analysis demonstrated the superiority of multi-modality management in the form of surgery and adjuvant radiation in the management of HN ACC  Invasion of skull base/ICE and lymph node involvement confers poor prognosis  Stratification of patients in risk groups may help identify those with greatest benefit from adjuvant RT  Molecular profiling may guide treatments in times to come

Editor's Notes

  1. Six patients (Palliative RT) and 3 received definitive RT