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f dyspnea on exertion and a dry cough in September 1980. A right-sided pleural effusion was noted and a decubitus chest x-ray revealed two nodular densities in the right mid-lung fields. Thoracentesis was performed and the fluid was found to contain malignant cells cytologically consistent with metastatic adenoid cystic carcinoma. A bone scan showed increased uptake over the pubis. L1, T5 and the right ribs; a liver spleen scan was normal. Serum chemistries revealed an elevation of the alkaline phosphatase to 339 U/L. A biopsy specimen of a cutaneous nodule located on the patient’s abdomen revealed metastatic carcinoma.
     On October 17, 1980, the patient received her first course of combination chemotherapy with FAM. Treatment was with 5-fluorouracil 500 mg/m2 and Adriamycin 30 mg/ m2 intravenously every four weeks. Mitomycin C was given on the first day and every eight weeks at a dosage of 10 mg/ m2. By February 26, 1981, examination of the patient' s chest x-ray showed improvement and the serum alkaline phosphatase had fallen to 118 U/L. A bone scan performed June 25, 1981 was normal. On July 2, 1981, the patient's chest XJ ray was clear her serum alkaline phosphatase was normal at 52 U/L, and physical examination revealed no evidence of disease. She remained in complete remission when seen on October 30, 1981. While still receiving therapy with FAM, the patient leads a physically active life and remains disease free after 12 months of treatment.
Discussion
     This is the second reported case of a complete remission of metastatic adenoid cystic carcinoma of the salivary gland induced by chemotherapy. The other reported complete response occurred following therapy with vincristine, intravenous cyclophosphamide, and Adriamycin. in that case, disease 13rogression had occurred during treatment with vincristine and oral cyclophosphamide, suggesting that Adriamycin was the agent responsible for the induction of remission. Partial responses have been reported following therapy with Adriamycin and the related anthracycline daunomycin. Of five patients with advanced carcinoma of the parotid gland treated with Adtiamycin, cisplatin and cyclophosphamide, two complete and three partial responses were reported, although none of these patient tumors demonstrated adenoid cystic histology. A single partial response to hexamethylmelamine therapy has been reported, although classical alkylating agents have not been effective. 5-Fluorouracil has been shown to have some activity against adenoid cystic carcinoma when given eigber intra-arterially or intravenously.
     Although the difficulties inherent in the retrospective assessment of the benefits of therapy in this uncommon and slow growing tumor system have been pointed out, objective responses can be documented. In our patient, a clear-cut improvement in performance status and lifestyle has accompanied a marked improvement in objective measures of disease, and a prolongation of survival might be presumed. Adriamycin would seem to be the most effective agent for the treatment of metastatic adenoid cystic carcinoma of the salivary glands, although 5-fluorouracil has also shown some activity. Because the tumor is uncommon, any prospective study would be bat done by a cooperative group, and should recognize the efficacy of Adriamycin, and perhaps 5-fluorouracil in the treatment of the disease.

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