專業(yè)英語 Unit 25教案.docx

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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(xué)本質(zhì)子宮頸 神經(jīng)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(shù)長春新堿正定霉素順鉗明確的生活自理能力轉(zhuǎn)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