Parotid cancer treatment with surgery followed by radiotherapy in Oxford over 15 years

Abstract

INTRODUCTION Primary parotid malignancies represent a rare diagnosis, making high-quality comparative research unfeasible. There is little UK-based evidence to guide practice. A review was therefore undertaken of a large series of patients treated by a multidisciplinary team in a National Health Service tertiary referral centre. PATIENTS AND METHODS Retrospective patient record review at the John Radcliffe Hospital in Oxford identified 401 patients who had undergone parotidectomy between 1995 and 2010, of whom 50 subjects were given a definitive diagnosis of primary parotid malignancy, treated with surgery and postoperative radiotherapy. Case notes, histology and imaging were reviewed by the study team. RESULTS The median follow up for the cohort was 60 months (range: 1-108 months). Facial nerve function was preserved in all patients undergoing partial or total conservative parotidectomy. Although histology showed microscopically close or positive margins in 82% of cases, all patients underwent postoperative radiotherapy and locoregional recurrence was identified in only two (4%) patients. CONCLUSIONS The data presented demonstrate a reasonable and practical multidisciplinary approach to a complex management problem. Facial nerve sparing surgery and postoperative radiotherapy result in good control of locoregional disease.

Adjuvant radiotherapy in malignant tumors of parotid. Experience of the Navarra Hospital Complex

“…The role of postoperative radiotherapy as an independent factor in locoregional control of tumors of the salivary glands and, especially, of the parotid glands, is based on retrospective studies [3][4][5][6][7][8][9][10][11]. The low incidence of these tumors makes it difficult to conduct prospective randomized trials.…”

Management of Regional Metastases of Malignant Salivary Gland Neoplasms

“…Postoperative radiotherapy significantly improved regional control in the clinically positive (N+) neck (86 vs. 62% for surgery alone). A more recent study of 50 patients with parotid gland cancer treated in the United Kingdom demonstrated excellent local control (96%) with surgery and postoperative radiotherapy [12] .…”

“…In many of these cases, the first echelon is represented by the intraparotid lymph nodes. The mean numbers of intraparotid lymph nodes that have been reported are 7 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] in the superficial lobe and 2 (range, 0-9) in the deep lobe [38] . Furthermore, a statistically significant correlation (p = 0.005) has been observed between the presence of intraparotid metastatic nodes and neck node metastases [39] .…”

Site-wise Differences in Adequacy of the Surgical resection Margins in Head and Neck Cancers

“…Though complete surgical excision of the tumor along with an adequate margin of histologically normal tissue remains the main aim of surgical treatment, much of the surgical literature details management plans tailored to specific histologic diagnoses although this diagnosis is usually not available definitively until the surgical excision has occurred [34]. Although the aim of surgical removal with clear margins would be agreed, the extent to which this may be achieved is complicated by the relationship between the tumor and the facial nerve.…”