Management of Parotid Metastatic Cutaneous Squamous Cell Carcinoma: Regional Recurrence Rates and Survival

Abstract

Objectives Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyzing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting A tertiary referral cancer center in Australia. Subjects and Methods The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or without neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results Of 78 patients, 65 underwent superficial parotidectomy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissections. Involved preauricular, facial, external jugular, and occipital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival-50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)-and improved 2-year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion This study supports surgery plus adjuvant radiotherapy as a standard of care for metastatic cSCC. The low incidence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required.

Metastatic Cutaneous Squamous Cell Carcinoma Involving the Parotid Gland: Experience Outside of the Sun Belt

“…The median age in our patient cohort was 76 years, and males accounted for 84.4% of patients. These findings are similar to those reported in other single and multi-institution studies originating from North America, 13-20 Australia, 21-28 and New Zealand. 29-31…”

Management of Salivary Gland Malignancy: ASCO Guideline

“…In addition, in a series of 64 patients who underwent surgery and adjuvant radiation therapy (RT) for metastatic squamous cell carcinoma to the parotid, a 3.7% rate of parotid bed recurrence was observed, with no difference seen based on extent of parotidectomy. 325 Consequently, given that adjuvant RT would be recommended in patients with advanced and/or high-grade parotid cancers (see Recommendation 3.2), it is advised for these patients to receive at least a superficial parotidectomy with removal of additional parotid tissue, when possible if it is deemed to not place the facial nerve at significant increased risk. Literature review and clinical interpretation.…”

Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma

“…16 Regarding the management of primary tumors and parotid metastases in patients with cSCCHN, there is general consensus on the fact that surgery followed by adjuvant radiotherapy when indicated is the most appropriate therapeutic strategy. 8,9,[17][18][19][20] Nevertheless, there is certain controversy regarding the optimal approach to the parotid gland. On one hand, the low recurrence rate at the parotid bed after lateral parotidectomy suggests that limited surgery is sufficient in case of P0 disease.…”