Parotid carcinoma: Current diagnostic workup and treatment

Abstract

In this review we present recent progress in diagnostic workup, prognostic evaluation, treatment options and resulting outcomes. Whenever possible, complete resection remains the mainstay of treatment. Sacrifice of facial nerve branches is reserved for the clinically or electromyographically dysfunctioning facial nerve. Clinical or radiological neck disease demands combined surgery and radiotherapy. Treatment of the N0 neck is indicated for advanced stage-high grade tumors but the question remains unanswered whether this should be surgical or radiotherapeutic elective treatment. Surgery alone will cure low stage, low grade tumors, that show no additional negative prognostic factors following adequate resection. In all other tumors postoperative radiotherapy will improve locoregional control. This approach results in good locoregional control, in a way that distant metastasis remains the typical presentation of treatment failure. In this setting, the results of systemic treatment today remain limited, but a huge effort in the molecular biology field has been done to introduce targeted therapy into this domain of head and neck cancer. Disease control remains variable within the patient population. This variation can increasingly be predicted by systems that incorporate the combined information of multivariately identified and quantified prognostic factors into an individualized prognosis for the parotid carcinoma patient.

Contemporary Management of Benign and Malignant Parotid Tumors

“…Furthermore, frozen sections are supportive when nerve resection is needed. Clear margins should be confirmed with frozen sections ( 78 ). Thereby, it is important to notice that adenoid cystic carcinoma is characterized by a specific tendency to spread along the facial nerve (and other nerve fibers) ( 74 ).…”

“…It is even possible that the patient still has a normal facial function but the adenoid cystic carcinoma has nevertheless already spread along the facial nerve. Finally, some surgeons perform frozen section of the subdigastric lymph nodes in a cN0 neck and perform a neck dissection in case of regional metastasis in the frozen section material ( 78 ).…”

Validated Prognostic Nomograms for Patients With Parotid Carcinoma Predicting 2- and 5-Year Tumor Recurrence-Free Interval Probability

“…Staging of SGM is complicated by the vast anatomical area they can arise in and the heterogenous histological appearance ( 4 ). Nowadays, if the tumor and eventual regional metastasis are resectable, surgery is the standard of care ( 5 , 6 ). Depending on the histopathological results adjuvant radiotherapy can be necessary.…”