Objective To examine the application of multi-disciplinary treatment(MDT)in the diagnosis and man-agement of recurrence and metastasis of adenoid cystic carcinoma(ACC)of the palate,as well as the treatment of concur-rent massive palatal bleeding.This article aimed to provide references for the diagnosis and treatment of patients with ad-vanced oral cancer,along with strategies for managing massive hemorrhage.Methods This article reported on the MDT process for a patient diagnosed with ACC of the left upper palate,who experienced skull base recurrence and lung metas-tasis following surgery and radiotherapy.The case was further complicated by massive palatal hemorrhage.Additionally,the article analyzed patients with ACC recurrence and significant hemorrhage in the context of relevant literature.The pa-tient was a 36-year-old female with ACC located in the left palate,initially diagnosed at clinical stage T3N0M0 in 2013.She underwent an extensive resection of the palatal lesion,followed by radioactive 125I seed implantation,which was guid-ed by a radiotherapy planning system(TPS)and a digital guide.The patient was monitored for four years post-surgery,during which no signs of tumor recurrence were observed.However,at the fifth year of follow-up,the patient developed recurrence with lung metastasis,classified as T4N0M1.Following a multidisciplinary consultation involving the oral and maxillofacial surgery,radiotherapy,medical oncology,and thoracic surgery,the patient underwent a procedure compris-ing left subtotal maxillary resection,autologous free flap transplantation,and thoracoscopic resection of pulmonary metas-tases.After surgery,the patient received 60 Gy of radiotherapy and was orally administered Anlotinib hydrochloride cap-sules to suppress tumor growth.After 31 months of follow-up,the patient reported experiencing slight bleeding in the mouth.A craniomaxillofacial CT scan revealed that the tumor had grown aggressively,resulting in destruction of the skull base.Consequently,the patient was admitted to the hospital.On the second day of admission,she experienced a sudden episode of oral bleeding.Despite the application of pressure,the bleeding continued unabated.An emergency tra-cheotomy was performed to relieve the obstruction of the patient's respiratory tract,and a red blood cell suspension was transfused to address the hemorrhagic shock.Following an urgent consultation with the vascular interventional surgery department,super-selective embolization was promptly employed to effectively halt the bleeding and achieve rapid vascu-lar occlusion.An individualized treatment plan was developed under MDT,incorporating postoperative radiotherapy,tar-geted therapies,and immunotherapy to manage the tumor.Results Through the MDT model,the patient successfully achieved emergency hemostasis,and normal vital signs were restored.With the addition of radiotherapy and immune-tar-geted drug treatment,tumor progression was effectively controlled,leading to an improved quality of life for the patient,who successfully survived for 129 months with the tumor by July 2024.A review of the relevant literature indicated that MDT offered significant advantages in the management of adenoid cystic carcinoma.In selecting surgical methods,the team administering MDT could comprehensively evaluate factors such as the patient's age,physical condition,tumor loca-tion,size,and extent of invasion to develop a personalized treatment plan.Radical surgical resection was a common treat-ment option for ACC.Postoperative tissue defects could be restored to their corresponding functions and aesthetic appear-ance through autologous tissue reconstruction,utilizing techniques such as peroneal myocutaneous flaps or iliac myocuta-neous flaps,or by the implantation of artificial materials.In complex cases involving positive margins,recurrence,and metastasis,the MDT model employed interdisciplinary collaboration to devise a comprehensive treatment plan that may have included re-operation,radiotherapy,and chemotherapy,with the aim of minimizing the risk of ACC recurrence and controlling distant metastasis.Massive bleeding resulting from advanced oral cancer presented a complex medical chal-lenge,influenced by various risk factors such as tumor type,metastasis,treatment options,and the patient's overall condi-tion.Early identification of bleeding risks,along with strategies to mitigate the adverse effects of bleeding on disease pro-gression—through supportive care,medical treatment,surgical intervention,and interventional therapy—could signifi-cantly enhance patients'quality of life.Conclusion The MDT model can provide comprehensive,precise,and personal-ized treatment plans for patients with advanced oral cancer and massive hemorrhage and improve the effectiveness of treatment strategies.
维普
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