UCSF ACC Series

Background

Retrospective single-institution series (UCSF). Head and neck adenoid cystic carcinoma (ACC) treated with surgery + adjuvant RT. Focus: perineural invasion, skull base involvement, RT technique. Endpoints: local control, patterns of failure.

Interventions and follow up

Treatment: Surgery + adjuvant RT; RT fields extended to cover cranial nerve pathways to skull base for perineural invasion / skull base extension
Primary endpoint: Local control, regional control, distant failure, survival
mFollow up: NR

Results

Local control: High rates with surgery + RT (quantitative figures NR in source)
High-risk features: Perineural invasion and skull base extension; RT fields routinely extended along cranial nerve pathways to skull base in these cases
Failure pattern: Distant metastasis the dominant long-term failure

Adverse events

Grading: Retrospective; toxicities not formally graded
Skull base RT risks: Temporal lobe injury, cranial nerve dysfunction

Conclusions

Surgery + adjuvant RT is effective for ACC. Perineural invasion warrants extended RT fields covering neural pathways. Distant failure remains the major challenge despite excellent locoregional control.

Key Limitations

Single-institution retrospective; non-standardized RT techniques over the accrual period; limited sample size; quantitative outcomes not detailed in source; selection bias inherent to retrospective design.

Clinical Context

Complements the UF (Mendenhall 2004) and Dutch NWHHT (Terhaard 2005) ACC series. Supports RT field extension to skull base (Gasserian ganglion for V2/V3, jugular foramen for lower cranial nerves) when clinical perineural invasion present. Modern practice uses IMRT with careful perineural pathway delineation; systemic options for metastatic ACC remain limited.

References