• 대한두경부종양학회지
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• 제15권2호
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• pp.182-188
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• 1999

Purpose: To investigate the treatment results' and patterns of failure according to the pathologic type of the parotid malignancy who were treated with radical sugery and postoperative radiation therapy. Materials and Methods: Fifty-two patients with various type of the parotid malignancy, who were treated with combined radical surgery and post-operative irradiation at Yonsei Cancer Center, between 1981 and 1995, were retrospectively reviewed after completion treatment, all but one patients were follow up with the median follow up period of 49 months. Results: We found that pathologically confirmed neck node metastasis rate was 28.8% all case and level II was most common site. Overall failure rate was 26.9%, local recurrence rate was 13.5%, node failure rate was 7.7%, and distant failure rate was 5.8%. Five-year disease free survival rate was 70.9%, and overall survival rate was 73.8%. Recurrence rate was low in adenoid cystic carcinoma and acinic cell carcinoma. However distant metastasis was very high in undifferentiated carcinoma. Local recurrence was main pattern of failure in mucoepidermoid carcinoma and nodal failure was frequently observed in adenocarcinoma. Conclusion: Individualized treatment plan may be required to improve a treatment outcome by pathologic subtype of the parotid malignancy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권5호
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• pp.390-394
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• 2002

Basal cell adenocarcinoma is an epithelial neoplasm which is cytologically and histomorphologically similar to basal cell adenoma but is different because of the infilitrative growth. This tumor, a rare salivary gland tumor newly classified as basal cell adenocarcinoma by the WHO in 1991, is infiltrative, locally destructive and tends to recur but metastasis is less common. The differential diagnosis includes basal cell adenoma, adenoid cystic carcinoma, and basaloid squamous carcinoma. Nearly 90 percent of these tumors occurr in the parotid gland and can be classified into low grade carcinomas with a relative good prognosis. Basal cell adenocarcinoma of minor salivary gland is very rare and has a less favorable clinical course compared with that of the major salivary glands. This is a case of basal cell adenocarcinoma occurring at the minor salivary gland of the soft palate. We treated this patient with block excision and adjunctive radiation therapy.

• Radiation Oncology Journal
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• 제12권1호
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• pp.43-50
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• 1994

1979년 3월부터 1989년 7월사이에 서울대학교병원 치료방사선과에서 55명의 환자가 이하선에 생긴 악성종양으로 치료를 받았다. 이 환자들을 대상으로 방사선 치료의 효과를 알아보기 위해 저자들은 후향성조사를 하였으며 다음과 같은 결과를 얻었다. 8명의 환자는 수술이 불가능하거나 재발한 경우로 방사선 치료만 받았으며 나머지 47명에게는 수술후 방사선 치료를 추가하였다. 이 환자들의 중앙추적기간은 48개월이었다. 조직학적으로는 mucoepidermoid ca가 25명으로 제일 많았으며 malignant mixed tumor와 adenoid cystic ca가 각각 12명, 6명이었다. 모든 환자에 있어서 국소치유율은 10년에 65.7%였으며 수술과 방사선 치료를 병합한 군이 방사선 단독 치료군보다 양호한 결과를 나타내었다(71.8% 대 28.6%). 조직학적 grade 및 종양의 크기, 임파절의 전이 여부가 국소치유율을 결정하는 요인이었으며 안면신경의 절제유무는 국소치유율에 영향을 주지 못했다. 원격전이는 환자의 23.6%에서 일어났으며 주로 high grade 병변에서 폐를 침범하였다. 전체생존율은 10년에 72.2%였으며 5년이후에는 plateau를 이루었다. 무병생존율은 10년에 49.4%였으며 수술과 방사선 치료를 병합한 군과 low grade 병변에서 좀 더 양호한 결과를 나타내었다. 결론적으로 이하선 악성종양의 치료에 있어서 이하선 절제술과 적절한 방사선치료를 병합함으로써 수술 혹은 방사선 단독 치료군보다 국소치유율의 향상 및 안면신경의 기능유지를 도모할 수 있으며 환자의 생존율을 높이기 위해서는 원격전이시 보다 효과적으로 작용하는 항암제의 개발이 시급하다 하겠다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8259-8263
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• 2014

Aims: To determine the clinical characteristics, pathological features, local and distant failure patterns in patients with carcinoma of major salivary glands treated with surgery and postoperative radiotherapy (PORT). Materials and Methods: We retrospectively reviewed 106 cases of major salivary gland tumor seen at our centre (1998-2008). Sixty five cases of major salivary gland carcinoma were selected for analysis (exclusions: benign, palliative, non-carcinomas). The patient population treated by surgery and PORT was divided into two groups: 1) Patients who underwent surgery and immediate PORT (Primary PORT); 2) Patients with recurrent carcinoma who underwent at least two surgeries and received PORT in the immediate post-operative period of the last performed surgery (Recurrent PORT). Recurrence free survival (RFS) was assessed using the Kaplan-Meier method. Results: Median age was 35 years with a male: female ratio of 1.3:1. The majority of cancers were located in the parotid gland (86.2%) and the most common histology was mucoepidermoid carcinoma (43%). Thirty nine cases (60%) were primary while 26 (40%) were recurrent. Optimal surgery was performed in 59/65 patients (90.8%). 43 patients (66.2%) underwent neck dissection, of which 14 (32.5%) had nodal metastasis. Overall, 61 (93.8%) patients complied with the prescribed radiotherapy. Median dose of PORT was 60 Gy. Median follow-up was 13.1 months (range 2-70). Relapse free survival was 50.4% at 60 months. Some 12 cases (18.5%) recurred with a median time to recurrence of 16.9 months. Conclusions: Surgery and PORT is an effective treatment for major salivary gland carcinoma with over 90% compliance and <20% recurrence. Early treatment with postoperative radiotherapy may increase the survival rate in major salivary gland carcinoma patients.

• 대한두경부종양학회지
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• 제19권2호
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• pp.127-132
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• 2003

Objectives: The best treatment for the malignant parotid tumor still remains to be defined, and a better knowledge about the tumor features that predict the treatment result is needed. The aim of this study is to evaluate the treatment outcomes and to suggest the optimal treatment modality for the parotid cancer. Materials and Methods: The clinicopathologic characteristics of 113 patients who were treated for parotid cancer from January 1990 to December 2002 were retrospectively analysed. Univalate analyses were performed to establish the prognostic influence of pateint age, gender, tumor size, histologic grade and lymph node metastasis. Results: The mean age was 46.4 years old (15-81 years) and. The male to female ratio was 1 : 1.1. The chief complaint was a palpable mass in 85%, pain was in 12.4% and facial nerve palsy was accompanied with 2.7%. The mean tumor size was 3.5cm in diameter. The most common malignant tumor was mucoepidermoid carcinoma (33.6%), followed by acinic cell carcinoma (15%), adenoid cystic carcinoma (11%), carcinoma expleomorhpic adenoma (11%), basal cell carcinoma (7%). The most common operative procedure was total parotidectomy (47.8%) and various types of cervical lymph node dissection were added in 69.9%. Postoperative radiotherapy was done in 61.1 %. Postoperative complications developed in 54 cases (47.8%), including 46 cases (40.7%) of facial nerve palsy and 9 cases (8%) of Frey's syndrome. Recurrences developed in 21 cases (18.6%) and deaths in 15 (13.3%). Cumulative survival at 5 year was 75.4%. Univariate analysis of clinical factors showed that histologic grade and positive cervical lymph node significantly influenced survival (p<0.05). Conclusion: These results suggests that the radical resection with lymph node dissection and postopertaive XRT would be necessary to improve the survival of the patients with high grade cancer or positive lymphnode metastasis.

• 대한두개안면성형외과학회지
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• 제9권1호
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• pp.23-26
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• 2008

Salivary duct carcinoma is a high-grade adenocarcinoma arising from the ductal epithelium and has very low prevalence. We report a case of salivary duct carcinoma in high risk group with satisfactory result. A 65-year-old male was referred to our clinic complaining of mass on Rt. cheek. Preoperative CT and MRI shows $2.0{\times}1.9cm$ sized multilobulated, cystic mass on the superficial lobe of Rt. parotid gland and multiple lymph node enlargement thorough the Rt. internal jugular chain. Total parotidectomy and modified radical neck dissection with adjuvant radiation therapy was performed. Pathologic result was salivary duct carcinoma and resection margin was free. Postoperative radiation therapy with 6400 cGy($200cGy{\times}12fx$) was performed. During the 24-months of follow up periods, recurrence or complications associated with operation and radiation therapy was not observed. Salivary duct carcinoma is rare disease with very poor prognosis. Lymph node metastasis is commonly accompanied at the time of diagnosis. Distant metastasis is the most common cause of death. Total parotidectomy, radical neck disssection and adjuvant radiation therapy can be the appropriate modality for the control of the salivary duct carcinoma especially in high risk group.

• 대한두경부종양학회지
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• 제7권2호
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• pp.129-136
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• 1991

This is a clinical, retrospective review of 66 cases of the Adenoid cystic carcinoma who were treated at the Department of Surgery, Presbyterian Medical Center, Chonju during the past 20 years from January, 1971 to December, 1990. The results were obtained as follows; 1) The most common malignant tumor in the minor salivary gland was adenoid cystic carcinoma and it's incidence was 57.6% (38 cases). 2) The most common site of adenoid cystic carcinoma in the major salivary gland was parotid gland with the incidence of 22.7% (15 cases). 3) The peak age of patients with adenoid cystic carcinoma was 5th decade(30.3%) and others' peak age except adenoid cystic carcinoma was 6th decade(35.9%). 4) The duration of symptoms of adenoid cystic carcinoma patient was less than one year in the minor salivary gland, comprising 21 cases(55.3 %) and more than one year in 18 cases(64.9 %) of the major salivary gland carcinoma. 5) According to histologic grades of 66 cases of adenoid cystic carcinoma, Grade I was 15 cases and Grade II 19 cases, Grade III 5 cases. Other 27 cases were undetermined. 6) The incidence of cervical lymphnode metastasis of 39 cases of adenoid cystic carcinoma classified into histologic grades was 0% in Grade I, 10.5% in Grade II and 20% in Grade III. 7) The incidence of nerve invasion confirmed histologically was 20% in Grade I, 63.2% in Grade II and 100% in Grade III. It was significant(p<0.01). 8) The local recurrence rate was 26.7% in Grade I, 47.4% in Grade II and 60% in Grade III. The lung was the commonest site for distant metastasis comprising 14 cases among 19 cases in which distant spread occurred. 9) 5 year determinate disease-free survival rate according to the histologic grade was 57.1% in Grade I, 27.3% in Grade II and 25.0% in Grade III. 10) The determinate 5-year survial rate of adenoid cystic carcinoma was 71.4% in the only curative surgery group, 70.6% in the combined treatment group of surgery and postoperative irradiation, 66.7% in the combined treatment group of surgery with postoperative irradiation and chemotherapy, and 33.3 % in the non-curative treatment group. 11) The average size of tumor was 3.6cm in Grade I, 4.8cm in Grade II and 4.5cm in Grade III.

• 대한기관식도과학회지
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• 제3권2호
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• pp.277-286
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• 1997

저자들은 1988년부터 1996년까지 중앙대학교 부속병원에서 수술적으로 치료한 47례의 타액선 종양환자를 대상으로 다음과 같은 결론을 얻었다. 1) 호발연령은 50대에서 가장 높았으며 악성종양의 경우 양성종양보다 호발연령이 높았다. 2) 여자에서 남자보다 호발하며 그 비율은 1.5;1 이었다. 3) 발생부위는 이하선이 가장 많아 48.9% 였으며, 악하선, 소타액선의 순이었으며 소타액선 종양은 구개에서 가장 많이 발생하였다. 4) 악성의 빈도는 소타액선에서 발생한 경우가 가장 높았으며, 악하선, 이하선 순이었다. 5) 가장 많은 증상은 무통성의 종물이었다. 6) 세침흡인 세포검사의 진단적 정밀도는 88.9% 였다. 7) 가장 흔한 타액선종양은 혼합종으로 전체의 57.4 %였다. 8) 악성종양 중 경부임파절 전이율은 22.2%였다. 9) 수술적 치료후 합병증의 발생률은 19.1% 였으며 일시적 안면신경마비가 가장 많았다.

• Nuclear Medicine and Molecular Imaging
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• 제41권5호
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• pp.359-363
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• 2007

목적 : FDG-PET을 시행하였을 때 이하선에서 우연히 발견되는 FDG 섭취병변은 원발암의 원격 전이로 오인될 수 있다. 이러한 이하선의 우연한 FDG 섭취병변에 대한 유병률과 임상-병리학적 소견에 관한 연구는 아직 시행되지 않았다. 본 연구에서는 FDG-PET검사시 우연히 발견된 이하선 FDG 섭취병변의 유병률과 악성위험도를 평가하였다. 대상 및 방법 : 본 병원에서 2003년 5월부터 2006년 12월까지 FDG-PET을 시행한 3,344명의 환자가 대상이었다. 이중 3,212명은 암이 알려져 있거나 암이 의심되어 FDG-PET을 시행하였으며, 132명은 암 조기 검진 목적으로 FDG-PET을 시행하였다. 이하선의 우연한 FDG 섭취병변은 이하선이 현재 FDG-PET을 실시한 관심병소가 아니면서 육안적으로 평가하였을 때 반대편 이하선보다 FDG 섭취가 국소적으로 증가되어 있는 경우로 정의하였다. FDG 섭취 정도는 최대 SUV값 (maxSUV)으로 제시하였다. 최종 진단은 병리학적 검사소견이나 임상적인 추적관찰결과를 토대로 하였다. 결과 : 15명 (0.45% = 15/3,344)의 환자에서 이하선의 우연한 FDG 섭취병변이 관찰되었으며, 이들은 모두 양성병변을 시사하는 소견을 나타내었다. MaxSUV의 범위는 1.7 에서 8.6(평균${\pm}$표준편차=$3.7{\pm}1.9$) 이었다. 최종 진단은 2명이 Warthin 종양, 1명이 pleomorphic adenoma, 다른 1명은 비특이적 양성 병변, 3명의 환자는 영상검사 추적결과 유의한 변화가 관찰되지 않았고, 8명의 환자는 임상적 추적관찰에서 유의한 변화가 관찰되지 않았다. 결론 : 본 연구에서 FDG-PET 검사시 우연히 이하선에 FDG 섭취를 보이는 병변이 0.45%의 유병률로 나타났으며 모두 양성병변을 시사하는 소견을 나타냈다. 우연히 이하선에 FDG 섭취를 보이는 병변이 발견될 경우 PET이나 CT를 이용한 면밀한 영상검사로 추적관찰을 하는 것이 병변의 진단을 위한 합리적인 접근방법이라고 생각된다.

• Radiation Oncology Journal
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• 제32권3호
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• pp.125-131
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• 2014

Purpose: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. Materials and Methods: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Results: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Conclusion: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.