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Case Reports
. 2024 Sep;42(3):237-243.
doi: 10.3857/roj.2024.00325. Epub 2024 Sep 10.

Long-term treatment of metastatic adenoid cystic carcinoma with sequential brachytherapy and stereotactic body radiotherapy

Allison Y Zhong  1 , Sangwoo S Kim  1 , Austin Hopper  1 , Greg White  1 , Sayuri Miyauchi  1 , Riley N Jones  1 , Dan Scanderbeg  1 , Loren K Mell  1 , Elizabeth Weihe  2 , Nathalie Boutros  1 , Stephen W Doggett  3 , Andrew B Sharabi  1
Affiliations
Case Reports

Long-term treatment of metastatic adenoid cystic carcinoma with sequential brachytherapy and stereotactic body radiotherapy

Allison Y Zhong et al. Radiat Oncol J. 2024 Sep.

Abstract

Adenoid cystic carcinoma is a malignancy that is difficult to treat and often metastasizes to the lung. Systemic chemotherapies are not effective for this tumor type, thus local therapies are frequently used. Here, we report a case demonstrating the use of extensive ablative interventions in controlling the progression of metastatic adenoid cystic carcinoma. A patient with adenoid cystic carcinoma developed numerous metastases to his lungs and liver. Local ablative therapies including interstitial brachytherapy and SBRT were used to treat approximately 80 different metastases over the course of a decade. Over 850 brachytherapy seeds were implanted in this patient, and the tumor control and patient outcome were good. As of the most recent follow-up in March 2024, the patient has survived for approximately 12 years since his diagnosis of adenoid cystic carcinoma. To our knowledge, this case represents the most brachytherapy treatments reported in a single patient. It highlights the utility of interstitial brachytherapy and SBRT in treating extensive lung and liver metastases.

Keywords: Adenoid cystic carcinoma; Brachytherapy; Neoplasm metastasis; Radiation; Radiotherapy.

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Conflict of interest statement

Conflict of Interest

A.B.S. reports research funding and honoraria from Pfizer and Varian Medical Systems/Siemens, consultant fees from Astrazeneca and Primmune, and other fees from Raysearch and Merck. A.B.S. has an equity interest in Toragen Inc. and Advanced B-cell Therapeutics outside of submitted work. The terms of this arrangement have been reviewed and approved by the University of California, San Diego in accordance with its conflict of interest policies. All other authors report no competing interests.

Figures

Fig. 1.
Fig. 1.
Sequence of all interventions from July 2012 to August 2023. IMRT, intensity-modulated radiotherapy; R, Right; L, Left; SBRT, stereotactic body radiotherapy.
Fig. 2.
Fig. 2.
Extensive interstitial lung brachytherapy treatment. (A) Chest X-ray posteroanterior (left) and lateral (right) images showing the extent of brachytherapy treatment implant sites. (B) Series of coronal images with anterior/posterior reference plane indicated in green line on corresponding sagittal reference image. Red arrows indicate locations of unique and separate brachytherapy treatment implant sites over multiple years. In total, approximately 70 sites were treated with over 850 seeds.
Fig. 3.
Fig. 3.
Dosimetry and plan sum of external beam and SBRT treatments. (A) Plan sum with isodose lines and 3-dimensional representation of external beam and SBRT treatment sites. (B) Coronal images with isodose lines for external beam and SBRT treatments. SBRT, stereotactic body radiotherapy.
Fig. 4.
Fig. 4.
Responses to (A) brachytherapy and (B) SBRT. (A) Axial images of lung nodules pre- and post-brachytherapy treatment (Tx) demonstrating complete response. (B) Axial images of lung nodules pre- and post-SBRT treatment demonstrating complete response. SBRT, stereotactic body radiotherapy.
See this image and copyright information in PMC

References

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