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Radiotherapy and Oncology : Journal of... Jan 2021The presence of previously unnoticed bilateral macroscopic salivary gland locations in the human nasopharynx was suspected after visualization by positron emission...
INTRODUCTION
The presence of previously unnoticed bilateral macroscopic salivary gland locations in the human nasopharynx was suspected after visualization by positron emission tomography/computed tomography with prostate-specific membrane antigen ligands (PSMA PET/CT). We aimed to elucidate the characteristics of this unknown entity and its potential clinical implications for radiotherapy.
MATERIALS AND METHODS
The presence and configuration of the PSMA-positive area was evaluated in a retrospective cohort of consecutively scanned patients with prostate or urethral gland cancer (n = 100). Morphological and histological characteristics were assessed in a human cadaver study (n = 2). The effect of radiotherapy (RT) on salivation and swallowing was retrospectively investigated using prospectively collected clinical data from a cohort of head-neck cancer patients (n = 723). With multivariable logistic regression analysis, the association between radiotherapy (RT) dose and xerostomia or dysphagia was evaluated.
RESULTS
All 100 patients demonstrated a demarcated bilateral PSMA-positive area (average length 4 cm). Histology and 3D reconstruction confirmed the presence of PSMA-expressing, predominantly mucous glands with multiple draining ducts, predominantly near the torus tubarius. In the head-neck cancer patients, the mean RT dose to the gland area was significantly associated with physician-rated post-treatment xerostomia and dysphagia ≥ grade 2 at 12 months (0.019/gy, 95%CI 0.005-0.033, p = .007; 0.016/gy, 95%CI 0.001-0.031, p = .036). Follow-up at 24 months had similar results.
CONCLUSION
The human body contains a pair of previously overlooked and clinically relevant macroscopic salivary gland locations, for which we propose the name tubarial glands. Sparing these glands in patients receiving RT may provide an opportunity to improve their quality of life.
Topics: Head and Neck Neoplasms; Humans; Male; Parotid Gland; Positron Emission Tomography Computed Tomography; Quality of Life; Radiotherapy, Conformal; Retrospective Studies; Salivary Glands; Xerostomia
PubMed: 32976871
DOI: 10.1016/j.radonc.2020.09.034 -
European Annals of Otorhinolaryngology,... Oct 2019Primary liposarcoma is very rare in the parotid gland. To date, only 8 cases of primary parotid liposarcoma have been reported. The aim of this study is to report on a...
INTRODUCTION
Primary liposarcoma is very rare in the parotid gland. To date, only 8 cases of primary parotid liposarcoma have been reported. The aim of this study is to report on a case of primary parotid liposarcoma highlighting the complexity of its treatment and analyze treatment outcomes of other reported cases.
CASE SUMMARY
We report a case of parotid liposarcoma arising in the left parotid gland of a 66 year-old man, causing local morbidity, recurrence, repeated surgical treatment and death 5 months after initial treatment.
DISCUSSION
Parotid liposarcoma is marked by a high probability of local recurrence of up to 70% and is prone to distant metastatic spread, as was the case in our patient. Based on limited experience from published literature, optimal treatment entails radical surgery with negative margins. Postoperative radiotherapy is an option for patients with large high-grade tumors, positive margins and involvement of complex anatomic subsites. High-grade tumors have a worse outcome despite the addition of surgery and postoperative radiotherapy.
Topics: Aged; Fatal Outcome; Humans; Liposarcoma; Male; Neck Dissection; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Rare Diseases; Skin Neoplasms
PubMed: 30876853
DOI: 10.1016/j.anorl.2018.01.013 -
JAMA Oncology Aug 2023Xerostomia is a major toxic effect associated with intensity-modulated radiotherapy (IMRT) for oropharyngeal cancers.
Weekly Adaptive Radiotherapy vs Standard Intensity-Modulated Radiotherapy for Improving Salivary Function in Patients With Head and Neck Cancer: A Phase 3 Randomized Clinical Trial.
IMPORTANCE
Xerostomia is a major toxic effect associated with intensity-modulated radiotherapy (IMRT) for oropharyngeal cancers.
OBJECTIVE
To assess whether adaptive radiotherapy (ART) improves salivary function compared with IMRT in patients with head and neck cancer.
DESIGN, SETTING, AND PARTICIPANTS
This phase 3 randomized clinical trial was conducted in 11 French centers. Patients aged 18 to 75 years with stage III-IVB squamous cell oropharyngeal cancer treated with chemoradiotherapy were enrolled between July 5, 2013, and October 1, 2018. Data were analyzed from November 2021 to May 2022.
INTERVENTIONS
The patients were randomly assigned (1:1) to receive standard IMRT (without replanning) or ART (systematic weekly replanning).
MAIN OUTCOMES AND MEASURES
The primary end point was the frequency of xerostomia, measured by stimulating salivary flow with paraffin. Secondary end points included salivary gland excretory function measured using technetium-99m pertechnetate scintigraphy, patient-reported outcomes (Eisbruch xerostomia-specific questionnaire and the MD Anderson Symptom Inventory for Head and Neck Cancer questionnaire), early and late toxic effects, disease control, and overall and cancer-specific survival.
RESULTS
A total of 132 patients were randomized, and after 1 exclusion in the ART arm, 131 were analyzed: 66 in the ART arm (mean [SD] age at inclusion, 60 [8] years; 57 [86.4%] male) and 65 in the standard IMRT arm (mean [SD] age at inclusion, 60 [8] years; 57 [87.7%] male). The median follow-up was 26.4 months (IQR, 1.2-31.3 months). The mean (SD) salivary flow (paraffin) at 12 months was 630 (450) mg/min in the ART arm and 584 (464) mg/min in the standard arm (P = .64). The mean (SD) excretory function of the parotid gland at 12 months, measured by scintigraphy, improved in the ART arm (48% [17%]) compared with the standard arm (41% [17%]) (P = .02). The 2-year-overall survival was 76.9% (95% CI, 64.7%-85.4%) in both arms.
CONCLUSIONS AND RELEVANCE
This randomized clinical trial did not demonstrate a benefit of ART in decreasing xerostomia compared with standard IMRT. No significant differences were found in secondary end points except for parotid gland excretory function, as assessed by scintigraphy, or in survival rates.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01874587.
Topics: Humans; Male; Female; Radiotherapy, Intensity-Modulated; Paraffin; Head and Neck Neoplasms; Xerostomia; Parotid Gland; Oropharyngeal Neoplasms
PubMed: 37261806
DOI: 10.1001/jamaoncol.2023.1352 -
The Laryngoscope May 2021To apply a novel sialography classification system to identify parotid and submandibular ductal findings following I-131 therapy and to assess correlates to dose and...
OBJECTIVES/HYPOTHESIS
To apply a novel sialography classification system to identify parotid and submandibular ductal findings following I-131 therapy and to assess correlates to dose and duration of symptoms.
STUDY DESIGN
Retrospective single-center case series.
METHODS
Patients who underwent sialography between February 2008 and February 2019 after previously receiving I-131 treatment were identified via a retrospective chart review. Their sialograms were systematically evaluated and scored by applying the Iowa parotid sialogram scale to also include submandibular gland analysis.
RESULTS
From 337 sialograms, 30 (five submandibular, 25 parotid) underwent analysis. Ductal stenosis was identified in all sialograms and was graded as moderate (>50%-75%) in 7/30 cases and severe (>75%) in 15/30 cases. The distal (main) duct was narrowed in 23/30 cases. No association was identified between degree of ductal stenosis and I-131 dose (P = .39), age (P = .81), or time from I-131 therapy to sialogram (P = .97).
CONCLUSIONS
The Iowa parotid sialogram scale was successfully applied to report abnormalities of the parotid and submandibular ductal system. The most common manifestation of I-131-associated sialadenitis was a severe stenosis within the distal salivary duct. No statistically significant association was found between degree of ductal stenosis and dose of I-131, age, or duration of symptoms.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:E1450-E1456, 2021.
Topics: Adult; Aged; Dose-Response Relationship, Radiation; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Parotid Diseases; Parotid Gland; Radiation Injuries; Radiotherapy Dosage; Retrospective Studies; Salivary Ducts; Sialadenitis; Sialography; Submandibular Gland; Submandibular Gland Diseases; Thyroid Diseases; Young Adult
PubMed: 33200832
DOI: 10.1002/lary.29279 -
In Vivo (Athens, Greece) 2022Human infection with the SARS-CoV-2 virus has caused a pandemic characterized by a plethora of diseases, of which those affecting the internal organs and nervous system...
BACKGROUND
Human infection with the SARS-CoV-2 virus has caused a pandemic characterized by a plethora of diseases, of which those affecting the internal organs and nervous system can have severe, life-threatening consequences. Among the manifestations of the disease at the viral entry site, diseases in oral mucosa adnexa are rarely reported. This case report describes a COVID-19-associated aggravating parotid gland disease.
CASE REPORT
The 47-year-old, SARS-CoV-2-positive male patient, already hospitalized and now in need of ventilation, had been referred for intensive care treatment due to increasing respiratory problems. A unilateral swelling of the cheek was noticed, the cause of which was initially a parotid gland infection. Examination ruled out mechanical causes of the parotid gland. During further treatment, the patient developed a parotid abscess, which was drained extra orally.
CONCLUSION
The oral cavity is primarily considered as a reservoir of the pathogen. There is an increasing number of reports detailing inflammation of the major salivary glands associated with SARS-CoV-2 virus. Knowledge of this association facilitates therapeutic decisions.
Topics: Abscess; COVID-19; Gastrointestinal Diseases; Humans; Male; Middle Aged; Parotid Gland; SARS-CoV-2
PubMed: 35478161
DOI: 10.21873/invivo.12837 -
Folia Morphologica 2022The parotid gland in sheep ends freely in front of the masseter muscle, and paracondylary section of occipital bone and extends deep until pterygoid extends of sphenoid...
BACKGROUND
The parotid gland in sheep ends freely in front of the masseter muscle, and paracondylary section of occipital bone and extends deep until pterygoid extends of sphenoid bone and hyoid bone. The structure of salivary glands in mammals has been thoroughly studied using histological and sialographic method. This study aimed to reveal the detailed anatomic features and race-specific differences of the canal system of the parotid glands in Akkaraman sheep by using the corrosion cast technique.
MATERIALS AND METHODS
Thirteen sheep parotid glands from 7 Akkaraman sheep were used in this study. Parotid glands were removed from their places with ducts. Measurements were made with a calliper from back to front, top to bottom and inside to outside. After dissection of the parotid glands, their volumes were measured according to the 'Archimedes principle'. Also, 13 sheep parotid glands were examined using the polyester resin method.
RESULTS
In the present study, our average metric results were: length of parotid duct was 10.92 ± 1.027 cm, length of parotid gland was 5.87 ± 1.04 cm, volume of parotid gland was 12.50 ± 2.48 cm³, thickness of parotid gland was 0.75 ± 0.36 cm and width of parotid gland was 4.07 ± 0.43 cm. The average weight of the parotid gland of Akkaraman sheep was identified as 25.3 g. Accessory parotid gland was not encountered in the current study.
CONCLUSIONS
It was observed that polyester entered into the parotid duct and filled up until the acinus and made both acinus and secretory ducts well-examined in this study. It was also observed that the parotid gland consisted of lobes and lobules. The average number of lobes was 12. The number of lobules in a lobe varied between 3 and 16, each lobe consisted of an average of 9 lobules. It was found that each lobe has its own lobar duct.
Topics: Animals; Parotid Gland; Salivary Glands; Sheep
PubMed: 34308540
DOI: 10.5603/FM.a2021.0071 -
Head & Neck Oct 2022It is important to define the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor (WT). This systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis Review
It is important to define the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor (WT). This systematic review and meta-analysis evaluated the accuracy of FNAC in the diagnosis of WT in the parotid gland and WT growth rate. For determination of FNAC accuracy, 17 studies, encompassing 1710 cases, were included. Pulled random model estimates of sensitivity, specificity, PPV, and NPV were 93.7% (95%CI: 92.1, 95.3), 97.9% (95%CI: 97, 98.9), 93.3% (95%CI: 91.5, 95.1), and 97.4% (95%CI: 96.4, 98.4), respectively. FNAC is highly reliable for the diagnosis of WT of the parotid. The high PPV value suggests that patients with a cytological diagnosis of WT of the parotid may be assigned to active surveillance.
Topics: Adenolymphoma; Biopsy, Fine-Needle; Humans; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Sensitivity and Specificity
PubMed: 35586869
DOI: 10.1002/hed.27099 -
ELife Sep 2021Management of salivary gland hypofunction caused by irradiation (IR) therapy for head and neck cancer remains lack of effective treatments. Salivary glands, especially...
Management of salivary gland hypofunction caused by irradiation (IR) therapy for head and neck cancer remains lack of effective treatments. Salivary glands, especially the parotid gland, actively uptake dietary nitrate and secrete it into saliva. Here, we investigated the effect of dietary nitrate on the prevention and treatment of IR-induced parotid gland hypofunction in miniature pigs, and elucidated the underlying mechanism in human parotid gland cells. We found that nitrate administration prevented IR-induced parotid gland damage in a dose-dependent manner, by maintaining the function of irradiated parotid gland tissue. Nitrate could increase sialin expression, a nitrate transporter expressed in the parotid gland, making the nitrate-sialin feedback loop that facilitates nitrate influx into cells for maintaining cell proliferation and inhibiting apoptosis. Furthermore, nitrate enhanced cell proliferation via the epidermal growth factor receptor (EGFR)-protein kinase B (AKT)-mitogen-activated protein kinase (MAPK) signaling pathway in irradiated parotid gland tissue. Collectively, nitrate effectively prevented IR-induced xerostomia via the EGFR-AKT-MAPK signaling pathway. Dietary nitrate supplementation may provide a novel, safe, and effective way to resolve IR-induced xerostomia.
Topics: Animal Feed; Animals; Diet; Dietary Supplements; Nitrates; Parotid Gland; Radiotherapy; Swine; Swine, Miniature; Xerostomia
PubMed: 34581269
DOI: 10.7554/eLife.70710 -
Medical Ultrasonography May 2022Contrast-enhanced ultrasound (CEUS) appears to be a promising application for the diagnosis of parotid gland tumours. We aimed to systematically review and meta-analyse... (Meta-Analysis)
Meta-Analysis Review
AIM
Contrast-enhanced ultrasound (CEUS) appears to be a promising application for the diagnosis of parotid gland tumours. We aimed to systematically review and meta-analyse the ability of CEUS in distinguishing benign from malignant parotid gland tumours.
MATERIAL AND METHODS
PubMed was searched for relevant studies. Data on area under time intensity curve (AUC) in arbitrary unit (AU), and mean transit time (MTT) in seconds (sec) were analysed using the Cochrane Review Manager Software.
RESULTS
Nine studies met the eligibility criteria comprising a total number of 498 parotid gland tumours (benign, number (n)=423; malignant, n=75). Descriptive evaluation of parotid gland tumours following CEUS administration showed overlap characteristics in benign and malignancies. Two publications assessed AUC and MTT in 72 and 60 parotid gland tumours, respectively. AUC was significantly lower in benign compared to malignant tumours following contrast administration (AUC, mean difference (MD) -266.77 AU, 95% confidence intervals (CI) -433.22, -100.33, p=0.002). No significant different in MTT between benign and malignant tumours (p=0.12). Heterogeneity was statistically significant in AUC (p=0.04) and MTT (p<0.00001).
CONCLUSION
Descriptive evaluation of parotid gland tumours showed overlap CEUS characteristics. Perfusion related CEUS parameters analysis is promising in differentiating benign parotid tumours from malignancies.
Topics: Contrast Media; Diagnosis, Differential; Humans; Parotid Gland; Parotid Neoplasms; Perfusion; Ultrasonography
PubMed: 34216453
DOI: 10.11152/mu-3119