Abstract
Objectives:
1) Recognize challenges in managing metastatic squamous cell carcinomas (SCC) to the parotid gland. 2) Describe our 5-year experience of treating metastatic SCC of the parotid gland.
Methods:
Retrospective case series of 22 consecutive patients undergoing parotidectomies for treatment of metastatic SCC to the parotid gland between August 2006 and December 2011 at Weill Cornell Medical College. Interventions included parotidectomy and radiation therapy (RT). Outcome measures included complications, survival, and locoregional recurrence.
Results:
Seventy-seven percent of patients were male, with a mean age of 77 years (range 46 - 93 years). Eighteen patients underwent superficial parotidectomy, four received total parotidectomy, and 16 underwent neck dissection. Fifteen patients received post-operative RT, and 1 patient had neoadjuvant radiation 4 months prior to surgery. Median dose of radiation delivered was 6300 cGy at 200 cGy per fraction. Overall 2-year survival was 77.4%, and 2-year disease-free survival was 33.3%. Recurrence rate was 54.5%, with a median time to recurrence of 14 months. The 2-year survival rate was 32% and 80% in patients with positive versus negative margins, respectively (P = .01). The 2-year survival rate was 56% and 100% in patients with positive versus negative cervical lymph nodes, respectively (P = 0.03). Five of 6 patients receiving conventional RT developed severe skin toxicity or could not complete treatment; none receiving intensity-modulated radiation therapy (IMRT) developed such complications.
Conclusions:
Positive lymph nodes in neck dissection specimens are an important prognostic factor in treating patients with metastatic SCC to the parotid gland. IMRT is better tolerated compared to conventional RT techniques.
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