APIS · ACC
Adenoid Cystic Carcinoma (ACC): Treatment Review in Korea
Carbon-ion or proton therapy may be relevant when adenoid cystic carcinoma (ACC) cannot be removed surgically, recurs or lies close to nerves and the skull base. Yonsei Cancer Center includes selected ACCs in its carbon-ion program, and Samsung Medical Center describes proton treatment for ACC. [10][11]
Nerve Involvement in ACC
ACC can grow along nerves. This can affect surgery and the area that radiation needs to cover. [3]
- Perineural invasion: microscopic involvement seen on pathology.
- Perineural spread: extension along a nerve that may be seen clinically or on imaging.
MRI may help show whether a nerve pathway toward the skull base is involved. This affects the treatment area; it does not by itself mean the cancer has spread throughout the body.
ACC often starts in salivary glands. It can grow slowly but recur years later or spread to distant organs, so both the local tumor and the wider disease need attention. [1]
Surgery and Postoperative Radiation
Surgery remains a main treatment when the tumor can be removed. Postoperative radiation is recommended for resected ACC. When surgery cannot safely remove the tumor, radiation can be the main local treatment. [2]
If ACC has returned, the hospital reviews surgery again alongside radiation and other options. If disease is progressing at several distant sites, systemic treatment or a clinical trial may matter more than radiation to one area. [4]
Can carbon-ion or proton therapy be used for ACC?
Carbon-ion therapy
ACC can be relatively resistant to conventional radiation. Carbon ions deliver a concentrated dose with a higher biological effect. Korean carbon-ion information includes difficult-to-operate non-squamous head and neck cancers such as ACC. [10]
Proton therapy
Protons can reduce radiation beyond the tumor. A proton plan is useful only if it can reduce dose to nearby organs without compromising treatment of the tumor. Proton therapy may be used after surgery or reviewed when surgery is not possible. [7][11]
These are options to discuss in the same hospital review, not choices you need to settle before contacting APIS. The tumor’s position, nerve involvement and previous treatment matter more than the treatment name.
ACC After Previous Radiation
Recurrence along a previously treated nerve pathway or at the skull base requires careful dose review. Existing injury and previous exposure of the optic nerves, brainstem and other nearby structures may limit another course.
Proton and Carbon-Ion Evidence
Clinical studies support both proton and carbon-ion treatment in particular ACC settings. Most published evidence is observational.
Carbon-ion evidence
The J-CROS multicenter study reported tumor control after carbon-ion treatment for head and neck ACC, including many advanced tumors. It supports a local-treatment option for difficult disease and also reports serious late effects that matter when planning treatment. [6]
Proton evidence
The Augustin series supports proton treatment after surgery and in some patients receiving radiation as their main local treatment. Most patients in that series had undergone surgery; it was not a re-irradiation study. [7]
Evidence for proton re-irradiation in ACC remains limited. [8]
These studies involve different patient populations and should not be used to compare proton and carbon-ion survival rates directly. Local control describes the treated area; it does not measure control of disease elsewhere in the body. [9]
Required Records for Hospital Review
For ACC, the hospital may later request pathology describing surgical margins and nerve involvement, and MRI covering the tumor and relevant nerve or skull-base pathways. If you had radiation, the previous plan may also be needed. [3]
General records and submission guidance. Korean hospital programs.
Treatment Schedule
Yonsei’s August 19, 2026 head and neck update describes 16 carbon-ion sessions over 4 weeks. This is a dated diagnosis-specific example; consultation, imaging and planning add time. [10]
Before travel, address swallowing, nutrition, pain and any breathing problems with your treating team. Agree how ongoing care and follow-up will be handled.
Planning time, hospital charges and travel costsExplore Review for ACC
Explore how the tumor’s location, nerve involvement and previous treatment affect the review.
Sources and dates
- National Cancer Institute. Salivary Gland Cancer Treatment PDQ, health professional version.
- Geiger et al. Management of Salivary Gland Malignancy: ASCO Guideline. Journal of Clinical Oncology, 2021. doi:10.1200/JCO.21.00449.
- Rodriguez-Russo et al. Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck. Cancers, 2021.
- van Herpen et al. ESMO–EURACAN salivary gland cancer clinical practice guideline. ESMO Open, 2022. doi:10.1016/j.esmoop.2022.100602.
- Sulaiman et al. Multicenter carbon-ion study for head and neck ACC, J-CROS 1402 HN. International Journal of Radiation Oncology Biology Physics, 2018. doi:10.1016/j.ijrobp.2017.11.010.
- Augustin et al. Long-Term Outcomes Following Definitive or Adjuvant Proton Radiotherapy for Adenoid Cystic Carcinoma. International Journal of Particle Therapy, 2024. doi:10.1016/j.ijpt.2024.100008.
- Yacoub et al. The Use of Protons in the Management of Recurrent, Previously Irradiated Adenoid Cystic Carcinoma. International Journal of Particle Therapy, 2026. doi:10.1016/j.ijpt.2025.101296.
- Rohit et al. A systematic review of particle-based treatment modalities for adenoid cystic carcinomas of the head and neck. Radiotherapy and Oncology, 2025. doi:10.1016/j.radonc.2025.111115.
- Yonsei Cancer Center. Official carbon-ion program expansion announcement, August 19, 2026 (Korean).
- Samsung Medical Center. Proton therapy for head and neck cancer.
Content reviewed October 23, 2026.