Management of salivary gland malignant tumor: the Policlinico Umberto I, “Sapienza” University of Rome Head and Neck Unit clinical recommendations

Felice, Francesca De; Vincentiis, Marco de; Valentini, Valentino; Musio, Daniela; Mezi, Silvia; Mele, Luigi; Monaca, Marco Della; D’Aguanno, Vittorio; Terenzi, Valentina; Brino, Martina Di; Brauner, Edoardo; Bulzonetti, Nadia; Tenore, Gianluca; Pomati, Giulia; Cassoni, Andrea; Tombolini, Mario; Battisti, Andrea; Greco, Antonio; Pompa, Giorgio; Minni, Antonio; Romeo, Umberto; Cortesi, Enrico; Polimeni, Antonella; Tombolini, Vincenzo

doi:10.1016/j.critrevonc.2017.10.010

Cited by 24 publications

(20 citation statements)

References 15 publications

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“…Therefore, chemotherapy is more of a palliative strategy aiming to improve quality of life and alleviate local symptoms. 26 Moreover, in spite of the emerging targeted therapies, all these drugs for metastatic SG malignancies are still at the stage of clinical trials. 6 , 27 …”

Section: Discussionmentioning

confidence: 99%

Prognostic value of primary tumor surgery in minor salivary-gland carcinoma patients with distant metastases at diagnosis: first evidence from a SEER-based study

Shi¹,

Huang²,

Shi³

et al. 2018

CMAR

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PurposeThe prognostic value of primary tumor surgery (PTS) in minor salivary-gland carcinoma (MiSGC) with distant metastasis (DM) at diagnosis has never been investigated. In this study, we aimed to provide the first evidence.Patients and methodsThe Surveillance, Epidemiology, and End Results (SEER) database was employed to identify MiSGC patients with DM at diagnosis. The prognostic value of PTS was evaluated by Kaplan–Meier methods, log-rank analyses, and multivariate Cox proportional-hazard regression models.ResultsOf the 152 eligible patients included in our study, 50 (32.9%) had undergone PTS. Kaplan–Meier analyses showed that the PTS group had >20% increase in 1- and 2-year overall survival (OS) and cancer-specific survival (CSS) compared with their counterparts without PTS (PTS group vs no-PTS group, 1-year OS 66.1% vs 43.9%, 1-year CSS 69.9% vs 44.9%, 2-year OS 56.6% vs 24.2%, 2-year CSS 59.9% vs 25.7%). Compared with the no-PTS group, multivariate analyses also demonstrated a significantly decreased risk of overall mortality (HR 0.601, 95% CI 0.379–0.952; P=0.031) and cancer-specific mortality (HR 0.547, 95% CI 0.336–0.891; P=0.015) in the PTS group. Subgroup multivariate analyses revealed patients with T1–T3 oropharynx, nasal cavity, or paranasal sinus primary MiSGC, especially adenoid cystic carcinoma, might benefit from PTS (all P<0.05).ConclusionPTS is associated with improved survival in highly selected MiSGC patients and may be considered in future clinical practice. However, prospective studies with larger sample size are still necessary to validate our findings.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of primary tumor surgery in minor salivary-gland carcinoma patients with distant metastases at diagnosis: first evidence from a SEER-based study

Shi¹,

Huang²,

Shi³

et al. 2018

CMAR

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“…Therefore, a multidisciplinary approach in the management of malignant tumors of the parotid tumors is needed, this may include total parotidectomy, neck dissection and/or adjuvant radiochemotherapy. [ 60 ]…”

Section: Discussionmentioning

confidence: 99%

Antegrade versus retrograde facial nerve dissection in benign parotid surgery: Is there a difference in postoperative outcomes? A meta-analysis

et al. 2018

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ObjectiveThe primary aim of this meta-analysis was to test the null hypothesis of no difference in facial nerve dysfunction in studies that compared classical antegrade facial nerve dissection (AFND) versus retrograde facial nerve dissection (RFND) during benign parotid surgery.MethodsA comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Google Scholar, Science Direct and relevant journals was undertaken up to June 27, 2018. Randomized controlled clinical trials (RCTs), controlled clinical trials (CCTs), and retrospective studies aimed at comparing the effect of AFND vs. RFND during parotidectomy were included. The outcome measures included facial nerve dysfunction, Frey’s syndrome, recurrence, silaocele, salivary fistula, operating time length of hospital stay, and estimated blood loss. Pooled risk ratio (RR) and weighted mean differences (MD) with 95% confidence intervals were calculated using either a fixed-effects or random-effects model.ResultsTen studies; four RCTs and five retrospective studies were included. There were 570 patients (319 in RFND group and 251 in AFND group). 481 patients in 9 studies reported the incidence rate of facial nerve dysfunction. No statistical significant difference was observed between both groups concerning the occurrence of transient or permanent facial nerve paralysis (p = 0.44 and 0.11 respectively). One out 10 studies reported the incidence rate of sialocele, however no statistical difference was observed between the two techniques. There was reduction in the operative time (19.30 min), amount of blood loss (25.08 ml) and amount of healthy salivary tissues removed (12.20 mm) in RFND compared with AFND.ConclusionsAccording to the results of the current review there is no evidence demonstrating a significant advantage of one approach over another, therefore, well-designed standardized RCTs are required.

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“…Moreover, neck dissection is recommended for high-grade tumors, those 3 4 cm in size, or in cases of clinicoradiological positive nodal disease. 16 In many case reports of PCAs, additional postoperative radiation therapy was also considered, 14 as in the current case. Considerations for adjuvant radiation therapy are driven by high histological grade, lymphovascular and perineural invasion, nodal metastases, and close surgical margins.…”

Section: Discussionmentioning

confidence: 94%

“…While clinical features are neither specific nor reliable in differentiating between high- and low-grade PCAs, certain clinical findings may suggest a malignant entity, such as the presence of a painless mass, lack of tenderness and a degree of fixation to surrounding tissues on palpation, and cranial VII neuropathy. 16 The radiological differential diagnosis of a solitary mixed cystic-solid parotid lesion is broad. Considerations include focal presentation of Sjogren syndrome, lymphoepithelial cysts, first branchial cleft cyst, Warthin’s tumor, acinic cell carcinoma, mucoepidermoid carcinoma, salivary duct carcinoma, and metastatic thyroid papillary carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…In general, adequate surgical margins for major salivary gland tumors are recommended and are often > 2 cm when excising high-grade tumors. 16 Higher stage and higher-grade parotid tumors, including the presence of an encased functional or impaired facial nerve, are strongly considered for complete parotidectomy. Moreover, neck dissection is recommended for high-grade tumors, those 3 4 cm in size, or in cases of clinicoradiological positive nodal disease.…”

Section: Discussionmentioning

confidence: 99%

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High-grade Features of Papillary Cystadenocarcinoma of the Parotid Gland

Wang

Kim

et al. 2019

Oman Med J

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Papillary cystadenocarcinomas (PCAs) are rare low-grade salivary gland tumors first introduced in the World Health Organization classification in 1991. While classically regarded as a low-grade malignancy, PCAs with more clinically and histologically high-grade features have been reported, reflecting the often-underrecognized morphological diversity of this entity. Although no universally advocated grading system exists, high-grade PCAs tend to demonstrate locally aggressive features, cytologic atypia, high mitotic rate, necrosis, and an absence of papillary features. We present a case of a 51-year-old male with slow-onset, progressive right facial fullness over four years. Contrast-enhanced computed tomography of the neck demonstrated a 3.3 cm peripherally enhancing cystic and solid mass in the right superficial lobe of the parotid gland. Following a superficial parotidectomy and a selective right neck dissection, histopathology demonstrated a large cyst with papillary projections lined with cuboidal cells of mild to moderate atypia and surrounding solid tumor nests. The tumor displayed stromal, lymphovascular, and subcutaneous fibroadipose tissue invasion. One of 12 lymph nodes was positive for metastatic carcinoma without extranodal extension. A diagnosis of intermediate-grade PCA was rendered. This case report summarizes the features typical of high-grade PCAs, the few reported cases of intermediate- and high-grade PCAs within the existing literature and provides a brief overview of the radiological and pathological differential diagnosis when considering a parotid gland PCA.

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Management of salivary gland malignant tumor: the Policlinico Umberto I, “Sapienza” University of Rome Head and Neck Unit clinical recommendations

Cited by 24 publications

References 15 publications

Prognostic value of primary tumor surgery in minor salivary-gland carcinoma patients with distant metastases at diagnosis: first evidence from a SEER-based study

Prognostic value of primary tumor surgery in minor salivary-gland carcinoma patients with distant metastases at diagnosis: first evidence from a SEER-based study

Antegrade versus retrograde facial nerve dissection in benign parotid surgery: Is there a difference in postoperative outcomes? A meta-analysis

High-grade Features of Papillary Cystadenocarcinoma of the Parotid Gland

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