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The Surgeon : Journal of the Royal... Feb 2020The true incidence of primary parotid squamous cell carcinoma (SCC) is unknown and likely overestimated in the literature. The aim of this systematic review is to...
INTRODUCTION
The true incidence of primary parotid squamous cell carcinoma (SCC) is unknown and likely overestimated in the literature. The aim of this systematic review is to examine the diagnosis, aetiology and incidence of parotid SCC by analysing studies evaluating primary parotid SCC.
METHODS
A systematic search of Medline, EMBASE and Cochrane library was performed. A narrative synthesis was done.
RESULTS
A total of 14 observational retrospective studies on primary parotid SCC were included. There are currently no standard criteria for ascertainment of primary parotid SCC. Primary parotid SCC is thought to be due to squamous metaplasia within the ductal epithelium and subsequent invasive squamous carcinoma. Histological features that favour primary disease includes SCC confined to parotid parenchyma with no direct communication to the skin and the absence of mucin. Incidence of primary parotid SCC varied from 1.54 to 2.8 cases per million person-years. Around 30%-86% of patients recorded to have primary parotid SCC on clinical records, when scrutinised, were in fact secondary to parotid lymph node involvement following regional advancement from skin or upper aerodigestive tract SCC.
CONCLUSION
Primary parotid SCC is rare and it is currently a diagnosis of exclusion. Thorough clinical assessment including endoscopy, preoperative imaging and the scrutiny of histopathological findings allow for differentiation between primary and secondary SCC within the parotid. This thus affects both initial treatment and subsequent follow-up.
Topics: Carcinoma, Squamous Cell; Global Health; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Parotid Neoplasms
PubMed: 31040083
DOI: 10.1016/j.surge.2019.03.006 -
Pediatric Blood & Cancer Mar 2019A systematic search of PubMed, EMBASE, and the Cochrane Library for studies from 2000 to 2017 including children aged 0-19 with salivary gland cancer was performed. In... (Meta-Analysis)
Meta-Analysis
A systematic search of PubMed, EMBASE, and the Cochrane Library for studies from 2000 to 2017 including children aged 0-19 with salivary gland cancer was performed. In 19 studies, 749 children (median age of 14.2 years, female to male ratio of 1.4:1) were included; 72% had parotid tumors and 95% underwent surgery, of whom 65% had surgery alone and 24% with adjuvant radiotherapy. Low-grade and stage mucoepidermoid carcinoma were the most frequent cancer. The 5-year overall- and disease-free survival was 94% and 83%. Recurrence was observed in 20% at a median of 1.1 years from diagnosis.
Topics: Combined Modality Therapy; Humans; Prognosis; Salivary Gland Neoplasms; Survival Rate
PubMed: 30378272
DOI: 10.1002/pbc.27543 -
European Archives of... Jun 2018The retrograde approach (RP) to nerve identification is a method seldom used in parotid surgery. A systematic review comparing this method to the standard anterograde... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The retrograde approach (RP) to nerve identification is a method seldom used in parotid surgery. A systematic review comparing this method to the standard anterograde approach (AP) with respect to facial nerve palsy (FNP) does not currently exist.
METHODS
In a meta-analysis according to the PRISMA statement, eight publications, including one randomized controlled trial, were selected. The primary aim was to compare the temporary and permanent FNP resulting from the two dissection methods. Facial nerve function was graded according to the House-Brackmann Scale. The secondary goal was a comparison of the cut-suture times (CST), the volume of healthy tissue (VHT) dissected, the rates of postoperative hematoma (PH), and postoperative infection (PI).
RESULTS
Temporary FNP was noted in 18.2% in the RP group as well as in 34.4% in the AP group. Permanent FNP occurred in 0.9% RPs and 2.4% APs. According to the mixed-effect logistic regression model, there was no significant difference between the two groups in the pooled odds ratio (OR) for either temporary [OR 2.64, 95% confidence interval (CI) 0.97-7.21] or permanent FNP (OR 4.31, 95% CI 0.44-42.28). The CST was significantly shorter in the RP group (p = 0.005), with a significantly smaller VHT dissected (p < 0.0001). There were no differences regarding PH and PI.
CONCLUSION
The RP is a safe procedure with no significant difference in FNP rates when compared to the AP and, considering the shorter CST and the lesser VHT resected in the RP, it is superior to the AP. Surgeons engaged in parotidectomy should be familiar with both methods of dissection.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bell Palsy; Child; Facial Paralysis; Female; Humans; Male; Middle Aged; Neck Dissection; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Young Adult
PubMed: 29679155
DOI: 10.1007/s00405-018-4982-8 -
Otolaryngology--head and Neck Surgery :... Apr 2023Various prognostic factors are associated with the survival of patients with parotid mucoepidermoid carcinoma (MEC). The aim of this systematic review is to summarize...
OBJECTIVE
Various prognostic factors are associated with the survival of patients with parotid mucoepidermoid carcinoma (MEC). The aim of this systematic review is to summarize the clinical and pathologic prognostic factors on survival outcomes in patients with parotid MEC.
DATA SOURCES
Articles published from database inception to July 2020 on OVID Medline, OVID Embase, Cochrane Central, and Scopus.
REVIEW METHODS
Studies were included that reported clinical or pathologic prognostic factors on survival outcomes for adult patients with parotid MEC. Data extraction, risk of bias, and quality assessment were conducted by 2 independent reviewers.
RESULTS
A total of 4290 titles were reviewed, 396 retrieved for full-text screening, and 18 included in the review. The average risk of bias was high, and quality assessment for the prognostic factors ranged from very low to moderate. Prognostic factors that were consistently associated with negative survival outcomes on multivariate analysis included histologic grade (hazard ratio [HR], 5.66), nodal status (HR, 2.86), distant metastasis (HR, 3.10-5.80), intraparotid metastasis (HR, 13.52), and age (HR, 1.02-6.86). Prognostic factors that inconsistently reported associations with survival outcomes were TNM stage, T classification, and N classification.
CONCLUSION
Histologic grade, nodal status, distant metastasis, intraparotid metastasis, and age were associated with worse survival outcomes. These prognostic factors should be considered when determining the most appropriate treatment and follow-up plan for patients with parotid MEC.
Topics: Adult; Humans; Prognosis; Neoplasm Staging; Carcinoma, Mucoepidermoid; Parotid Neoplasms; Disease-Free Survival; Retrospective Studies
PubMed: 35316125
DOI: 10.1177/01945998221086845 -
Auris, Nasus, Larynx Aug 2022To evaluate surgical approaches and outcomes of pleomorphic adenoma of parotid gland in pediatric population. (Review)
Review
OBJECTIVES
To evaluate surgical approaches and outcomes of pleomorphic adenoma of parotid gland in pediatric population.
METHODS
A systematic search of PubMed and EMBASE was performed to identify articles reporting surgical treatment of pleomorphic adenoma of the parotid gland in children. A qualitative analysis on results was conducted.
RESULTS
Our search included 23 retrospective studies. The number of children with pleomorphic adenoma underwent surgical treatment were 330. Superficial parotidectomy is the most reported type of surgery, total parotidectomy is performed when the tumor occurs in the deep lobe or in revision surgery and limited excisions in selected case of small lesions mainly in the tail of parotid gland. The rate of recurrences after surgery ranged from 0% to 44.4%. Revision surgery was performed in all cases of recurrences. Considering major complications, transient facial paralysis was observed from 0% to 50% of cases after primary and/or revision surgery; Frey's syndrome from 0% to 14.3% of cases regardless of the type of surgeries.
CONCLUSION
Surgical treatment of pleomorphic adenoma of parotid gland in children requires a tailored approach based on the location and extent of the tumor with the main aim of complete excision of the neoplasm. Appropriate surgical approach results in a decrease of recurrence rate and morbidity. Surgical skill is needed to reduce complication rates especially in children.
Topics: Adenoma, Pleomorphic; Child; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Recurrence; Retrospective Studies
PubMed: 35101285
DOI: 10.1016/j.anl.2022.01.013 -
Acta Oncologica (Stockholm, Sweden) Nov 2023Head and neck cancer (HNC) patients' anatomy may undergo significant changes during radiotherapy (RT). This potentially affects dose distribution and compromises...
INTRODUCTION
Head and neck cancer (HNC) patients' anatomy may undergo significant changes during radiotherapy (RT). This potentially affects dose distribution and compromises conformity between planned and delivered dose. Adaptive radiotherapy (ART) is a promising technique to overcome this problem but requires a significant workload. This systematic review aims to estimate the clinical and dosimetric benefits of ART using prospective data.
MATERIAL AND METHODS
A search on PubMed and Web of Science according to the PRISMA guidelines was made on Feb 6, 2023. Search string used was: 'adaptive radiotherapy head neck cancer'. English language filter was applied. All studies were screened for inclusion on title and abstract, and the full text was read and discussed in the research group in case of uncertainty. Inclusion criteria were a prospective ART strategy for HNC investigating clinical or dosimetric outcomes.
RESULTS
A total of 1251 articles were identified of which 15 met inclusion criteria. All included studies were published between 2010 and 2023 with a substantial diversity in design, endpoints, and nomenclature. The number of patients treated with ART was small with a median of 20 patients per study (range 4 to 86), undergoing 1-2 replannings. Mean dose to the parotid glands was reduced by 0.4-7.1 Gy. Maximum dose to the spinal cord was reduced by 0.5-4.6 Gy. Only five studies reported clinical outcome and disease control was excellent. Data on toxicity were ambiguous with some studies indicating reduced acute toxicity and xerostomia, while others found reduced quality of life in patients treated with ART.
CONCLUSION
The literature on clinical ART in HNC is limited. ART is associated with small reductions in doses to organs at risk, but the influence on toxicity and disease control is uncertain. There is a clear need for larger, prospective trials with a well-defined control group.
Topics: Humans; Head and Neck Neoplasms; Organs at Risk; Prospective Studies; Quality of Life; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 37560990
DOI: 10.1080/0284186X.2023.2245555 -
American Journal of Clinical Pathology May 2020Sjögren syndrome (SS) is considered as a major etiologic factor for primary salivary gland lymphoma (SGL). However, the percentage of SGL that is caused by SS (and thus... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Sjögren syndrome (SS) is considered as a major etiologic factor for primary salivary gland lymphoma (SGL). However, the percentage of SGL that is caused by SS (and thus the real impact of SS on SGL epidemiology) is unclear. We aimed to assess the prevalence of SS in patients with SGL through a systematic review and meta-analysis.
METHODS
Electronic databases were searched for studies assessing the presence of SS in patients with SGL. Pooled prevalence of SS in SGL was calculated, with a subgroup analysis based on histotype (mucosa-associated lymphoid tissue [MALT] vs non-MALT).
RESULTS
Sixteen studies with 665 SGLs were included. Pooled prevalence of SS in SGL was 18.2%, with high heterogeneity among studies. In MALT SGL, the prevalence of SS was 29.5%, with moderate heterogeneity. In non-MALT SGL, the prevalence of SS was 0%, with null heterogeneity.
CONCLUSIONS
SS seems to be responsible for a significant but minor portion of SGLs. SS appears involved in MALT-type SGL but not in other histotypes.
Topics: Humans; Lymphoma; Salivary Gland Neoplasms; Salivary Glands; Sjogren's Syndrome
PubMed: 32076706
DOI: 10.1093/ajcp/aqaa005 -
La Radiologia Medica Oct 2022To assess the diagnostic utility of various radiologic criteria such as the lateral margin or dislocation of the retromandibular vein (RMV), Utrecht line, facial nerve... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the diagnostic utility of various radiologic criteria such as the lateral margin or dislocation of the retromandibular vein (RMV), Utrecht line, facial nerve line, Conn's arc, lines passing from the lateral margin of the masseter muscle to the facial nerve trunk or RMV, minimum distance from the fascia to the tumor (MDFT), and direct tracing of the intraparotid facial nerve (DT) for differentiating a parotid deep lobe tumor from a superficial lobe tumor.
METHODS
Twenty-one studies with 2225 participants from PubMed, Embase, Web of Science, Cochrane Library, SCOPUS, and Google Scholar up to March 2022 were analyzed. Sensitivity, specificity, and negative and positive predictive values of the methods were extracted.
RESULTS
The diagnostic odds ratio (DOR) of radiologic criteria compared to surgical findings was 18.9109. The area under the summary receiver operating characteristic curve was 0.879. The sensitivity and specificity were 0.6663 and 0.9190. MDFT (DOR 61.2917) and DT (DOR 91.9883) showed superior results as diagnostic landmarks. For tumors crossing the anatomical criteria line, strict way (any tumor crossing the line) could help differentiate a deep lobe tumor more accurately than conventional way (> 50% of the tumor volume located medial to the line).
CONCLUSION
Various radiologic criteria, especially MDFT and DT, showed good diagnostic accuracy for differentiating a parotid deep lobe tumor.
Topics: Facial Nerve; Humans; Parotid Gland; Parotid Neoplasms; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity
PubMed: 36018486
DOI: 10.1007/s11547-022-01540-2 -
Annals of Surgical Oncology Jul 2021The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do so remain controversial. This systematic review aimed to determine the rate of occult nodal metastasis for each neck level, and consequently, to elucidate the proper extent of elective neck dissection (END).
METHODS
A meta-analysis of all studies that included patients with a diagnosis of parotid malignancies who underwent an END was performed. The risk for occult nodal metastasis was calculated for each neck level separately.
RESULTS
The search strategy identified 124 papers from January 1980 to December 2019 in the various databases. Nine retrospective studies (n =548) met the inclusion criteria. The risk for occult neck nodal metastasis ranged from 0.0 to 9.43% with a random-effect model of 2.2% for level 1 (n =459), from 3.4 to 28.38% with a random-effect model of 16.51% for level 2 (n =548), from 0.0 to 21.63% with a random-effect model of 4.23% for level 3 (n =518), from 0.0 to 17.02% with a fixed-effect model of 0.39% for level 4 (n =310), and from 0.0 to 11.63% with a fixed-effect model of 1.7% for level 5 (n =417).
CONCLUSION
The rate of occult neck nodal metastasis in parotid malignancies is low, with neck level 2 the most commonly involved. The results of this meta-analysis prevented the authors from substantiating the appropriate extent of an END in parotid cancer.
Topics: Carcinoma; Humans; Neck Dissection; Neoplasm Staging; Parotid Neoplasms; Retrospective Studies
PubMed: 33175260
DOI: 10.1245/s10434-020-09331-7 -
The Annals of Otology, Rhinology, and... Nov 2017Salivary gland dysfunction as a consequence of radioiodide ablation is present in as many as two-thirds of patients, and unfortunately, many of these individuals do not... (Review)
Review
OBJECTIVES
Salivary gland dysfunction as a consequence of radioiodide ablation is present in as many as two-thirds of patients, and unfortunately, many of these individuals do not respond to conservative measures. Sialendoscopy as a minimally invasive therapeutic modality may have utility in the treatment of radioiodide induced sialadenitis (RAIS). Our aim was to explore whether sialendoscopy resulted in clinical improvement in patients with RAIS.
METHODS
A systematic review of studies on sialendoscopy for RAIS was conducted using MEDLINE database, Embase, and Cochrane Library. The outcomes of interest included the proportion of patients demonstrating clinical improvement after intervention, patient demographics, radiation dose, specific procedural variations, specific salivary gland, failure rate, and recurrence.
RESULTS
Eight studies met inclusion criteria. Data reviewed showed an increased predilection of parotid sialadenitis relative to submandibular gland sialadenitis. All but 2 studies employed sialendoscopy only after failure of conservative measures. An overall rate of clinical improvement ranging from 75% to 100% was reported.
CONCLUSION
This systematic review encompassing 122 patients represents the largest pooled sample to date of patients undergoing sialendoscopy for RAIS. Sialendoscopy represents an invaluable minimally invasive modality that may obviate the need for more invasive surgery as intervention was associated with a high success rate.
Topics: Endoscopy; Humans; Iodine Radioisotopes; Sialadenitis; Thyroid Neoplasms; Treatment Outcome
PubMed: 28949251
DOI: 10.1177/0003489417732795