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Journal of Medical Radiation Sciences Jun 2023Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy...
INTRODUCTION
Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy technique, dose and volumes are seldom described sufficiently to allow close examination. We report our treatment outcomes and focus on treatment-related factors that affect outcomes in this cohort.
METHODS
We performed a retrospective review of patients with metastatic cutaneous SCCs who underwent parotidectomy with or without ipsilateral neck dissection. All patients received adjuvant radiotherapy. Demographics, clinical data and treatment details were collected from an intuitional electronic database. Individual patient-level radiotherapy technique, volumes and doses were reviewed.
RESULTS
Between July 2008 and July 2018, 60 patients met our inclusion criteria. Median follow-up duration was 32.7 months. The mean age was 66.4 years. The majority of patients (49 patients) received full neck irradiation. The 2-year and 5-year loco-regional failure-free survival was 87% (95% confidence interval (CI): 0.74-0.93) and 71% (95% CI: 0.52, 0.83), respectively. The 2-year and 5-year overall survival was 76% (95% CI: 0.62, 0.85) and 60% (95% CI: 0.45, 0.72), respectively. There were 15 cases of loco-regional failures, with 6 cases with dermal involvement. Lymphovascular invasion (LVI) was associated with higher loco-regional failure (hazard ratio: 8.43, 95% CI: 1.85-38.39, P = 0.005) and cancer-specific mortality (hazard ratio: 5.40, 95% CI: 1.40-20.87, P = 0.015). Treatment technique, intensity-modulated radiation therapy (IMRT) vs 3D conformal radiotherapy (3D CRT), bolus use, perineural invasion (PNI) and surgical margins were not significantly associated with loco-regional failure.
CONCLUSION
We demonstrated high loco-regional control rates with routine use of comprehensive adjuvant radiotherapy. The presence of LVI was identified as a strong predictor for recurrence. Further analysis will help to define optimal radiation dose and techniques.
Topics: Humans; Aged; Carcinoma, Squamous Cell; Skin Neoplasms; Parotid Gland; Radiotherapy, Adjuvant; Treatment Outcome; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Retrospective Studies
PubMed: 36790039
DOI: 10.1002/jmrs.650 -
The Laryngoscope Jul 2020Characterize long-term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM).
OBJECTIVE
Characterize long-term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM).
METHODS
Longitudinal review of HNCM patients undergoing SLNB from 1997-2007.
RESULTS
Three hundred fifty-six patients were identified, with mean age 53.5 ± 19.0 years, mean Breslow depth 2.52 ± 1.87 mm, and 4.9 years median follow-up. One hundred five (29.4%) patients had SLNB mapping to the parotid basin. Eighteen patients had positive parotid SLNs and underwent immediate parotidectomy / immediate completion lymph node dissection (iCLND), with six possessing positive parotid non-sentinel lymph nodes (NSLNs). Fifty-two of 356 (14.6%) patients developed delayed regional recurrences, including 20 total intraparotid recurrences: five following false negative (FN) parotid SLNB, three following prior immediate superficial parotidectomy, two following iCLND without parotidectomy, and the remaining 12 parotid recurrences had negative extraparotid SLNBs. Parotid recurrences were multiple (4.9 mean recurrent nodes) and advanced (n = 4 extracapsular extension), and all required salvage dissection including parotidectomy. Immediate parotidectomy/iCLND led to no permanent CN injuries. Delayed regional HNCM macrometastasis precipitated 16 total permanent CN injuries in 13 patients: 10 CN VII, five CN XI, and one CN XII deficits. Fifty percent (n = 10) of parotid recurrences caused ≥1 permanent CN deficits.
CONCLUSIONS
Regional HNCM macrometastases and salvage dissection confer marked CN injury risk, whereas early surgical intervention via SLNB ± iCLND ± immediate parotidectomy yielded no CN injuries. Further, superficial parotidectomy performed in parotid-mapping HNCM does not obviate delayed intraparotid recurrences, which increase risk of CN VII injury. Despite lack of a published disease-specific survival advantage in melanoma, early disease control in cervical and parotid basins is paramount to minimize CN complications.
LEVEL OF EVIDENCE
4 (retrospective case series) Laryngoscope, 130:1707-1714, 2020.
Topics: Cranial Nerve Injuries; Cranial Nerves; Disease-Free Survival; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Neck; Neoplasm Recurrence, Local; Prospective Studies; Sentinel Lymph Node Biopsy; Skin Neoplasms; Time Factors; United States; Melanoma, Cutaneous Malignant
PubMed: 31441955
DOI: 10.1002/lary.28243 -
Brazilian Journal of Otorhinolaryngology 2021Regional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival,...
INTRODUCTION
Regional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis.
OBJECTIVE
The purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis.
METHODS
A retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained.
RESULTS
Thirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ‒ HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02).
CONCLUSION
Head and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Neoplasms; Prognosis; Retrospective Studies; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck
PubMed: 31870740
DOI: 10.1016/j.bjorl.2019.10.007 -
In Vivo (Athens, Greece) 2023This study aimed to assess the effect of adjuvant radiotherapy on locoregional control, disease-free survival, and overall survival rates in patients with major salivary...
BACKGROUND/AIM
This study aimed to assess the effect of adjuvant radiotherapy on locoregional control, disease-free survival, and overall survival rates in patients with major salivary gland malignancies. The study also aimed to provide findings to guide clinicians in selecting appropriate candidates for adjuvant radiotherapy and optimizing treatment strategies for this challenging disease.
PATIENTS AND METHODS
A retrospective single-center analysis was conducted, reviewing the medical records of patients diagnosed with major salivary gland malignancies between November 2008 and May 2023. Inclusion criteria were histologically confirmed malignancy, surgical resection of the primary tumor, adjuvant radiotherapy, and availability of clinical and follow-up data. Survival analyses were performed using the Kaplan-Meier method, and Cox proportional hazards regression models were used to assess survival outcomes.
RESULTS
The study included 37 patients with major salivary gland malignancies. The most common site was the parotid gland, and the predominant histopathological diagnosis was salivary duct carcinoma. Adjuvant radiotherapy was generally well-tolerated, with the most common acute toxicities being grade 1-2 mucositis and dermatitis. The 5-year overall survival and progression-free survival rates were 93.8% and 62.9%, respectively. Locoregional control rate at five years was 89.1%. Recurrence occurred in 12 patients, with most cases observed within two years from the start of adjuvant radiotherapy. Distant metastasis was observed in nine patients.
CONCLUSION
This retrospective analysis highlights the positive impact of adjuvant radiotherapy on locoregional control and survival outcomes in major salivary gland malignancies. The findings contribute to the existing body of evidence, aiding clinicians in treatment decision-making and potentially informing future prospective studies and treatment guidelines for this challenging disease.
Topics: Humans; Radiotherapy, Adjuvant; Retrospective Studies; Prospective Studies; Salivary Gland Neoplasms; Disease-Free Survival; Neoplasm Recurrence, Local; Survival Rate; Neoplasm Staging
PubMed: 37905628
DOI: 10.21873/invivo.13391 -
Scientific Reports Aug 2021To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with...
To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with parotid tumors treated surgically were analyzed. Of which, 19 had parotid malignancy and 36 had WTs confirmed with postoperative histopathological examination. Accuracy of DCE-MRI parameters (T and WR) was compared with the histopathological diagnosis. ROC analysis was performed to determine sensitivity and specificity of DCE-MRI with various T and WR cut-off values. WT showed significantly lower median T and higher median WR than malignant lesions. The cut-off values for T and WR providing maximum sensitivity (84.2%) and specificity (86.1%) for malignant tumors were T > 60 s and WR ≤ 30%. Different diagnostic algorithm, i.e., lower cut-off value for T (T = 60 s), increases sensitivity of DCE-MRI in differentiating parotid malignancies from WTs. However, WR > 30% seems to be a key diagnostic criterion for benign lesions. Precise and reliable preoperative diagnostics of parotid tumors aids in careful surgical planning, thereby assisting in achieving sufficient surgical resection margins and facial nerve preservation.
Topics: Adenolymphoma; Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Humans; Male; Middle Aged; Parotid Neoplasms; ROC Curve; Sensitivity and Specificity; Young Adult
PubMed: 34381113
DOI: 10.1038/s41598-021-95820-y -
European Annals of Otorhinolaryngology,... May 2020
Topics: Carcinoma, Mucoepidermoid; Humans; Male; Middle Aged; Parotid Neoplasms
PubMed: 31980403
DOI: 10.1016/j.anorl.2020.01.004 -
Head and Neck Pathology Sep 2022Correct diagnosis of a parotid neoplasm based on histology preoperatively is of utmost importance in order to guide patient management. The aim of this study was to...
Correct diagnosis of a parotid neoplasm based on histology preoperatively is of utmost importance in order to guide patient management. The aim of this study was to evaluate the diagnostic accuracy of an ultrasound-guided core needle biopsy of a parotid lesion and to describe associated post-procedural complications. A retrospective study was conducted between January 2015 and March 2021 of all patients who were referred to a tertiary care center for evaluation of a parotid lesion and who underwent core needle biopsy due to high-risk features or when malignancy was suspected on clinical examination or ultrasonography. Patient characteristics, histological findings, and post-procedural complications were recorded and evaluated. Among 890 patients referred for evaluation of a parotid lesion, in 138 patients a core needle biopsy was undertaken. On the basis of core needle biopsy findings, 11 lymphomas and 82 non-lymphoma malignancies were diagnosed in the parotid gland. The sensitivity of the core needle biopsy predicting the accurate tumor type was 97.56% (95% CI 91.47-99.70%) and the specificity 94.64% (95% CI 85.13-98.88%). The accuracy for the correct histopathological diagnosis was 93.48% (95% CI 87.98-96.97%). Post-procedural minor complications occurred in 19 patients (13.8%). In conclusion, a core needle biopsy can identify malignancy in the parotid gland with high sensitivity and specificity in a safe manner and therefore guide surgical treatment.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Humans; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Sensitivity and Specificity; Ultrasonography; Ultrasonography, Interventional
PubMed: 34919166
DOI: 10.1007/s12105-021-01401-w -
International Journal of Molecular... Jul 2021Salivary gland cancers are rare but aggressive tumors that have poor prognosis and lack effective cure. Of those, parotid tumors constitute the majority. Functioning as...
Salivary gland cancers are rare but aggressive tumors that have poor prognosis and lack effective cure. Of those, parotid tumors constitute the majority. Functioning as metabolic machinery contributing to cellular redox balance, peroxisomes have emerged as crucial players in tumorigenesis. Studies on murine and human cells have examined the role of peroxisomes in carcinogenesis with conflicting results. These studies either examined the consequences of altered peroxisomal proliferators or compared their expression in healthy and neoplastic tissues. None, however, examined such differences exclusively in human parotid tissue or extended comparison to peroxisomal proteins and their associated gene expressions. Therefore, we examined differences in peroxisomal dynamics in parotid tumors of different morphologies. Using immunofluorescence and quantitative PCR, we compared the expression levels of key peroxisomal enzymes and proliferators in healthy and neoplastic parotid tissue samples. Three parotid tumor subtypes were examined: pleomorphic adenoma, mucoepidermoid carcinoma and acinic cell carcinoma. We observed higher expression of peroxisomal matrix proteins in neoplastic samples with exceptional down regulation of certain enzymes; however, the degree of expression varied between tumor subtypes. Our findings confirm previous experimental results on other organ tissues and suggest peroxisomes as possible therapeutic targets or markers in all or certain subtypes of parotid neoplasms.
Topics: Adenoma, Pleomorphic; Carcinoma, Acinar Cell; Carcinoma, Mucoepidermoid; Case-Control Studies; Humans; Neoplasm Proteins; Parotid Gland; Parotid Neoplasms; Peroxisome Proliferator-Activated Receptors; Peroxisomes
PubMed: 34360635
DOI: 10.3390/ijms22157872 -
Journal of Oral and Maxillofacial... Aug 2023During the preoperative evaluation of parotid gland tumors, one of the main concerns is to determine the location of the tumors in relation to the facial nerve. This...
PURPOSE
During the preoperative evaluation of parotid gland tumors, one of the main concerns is to determine the location of the tumors in relation to the facial nerve. This study aims to assess the value of ultrasound for determining the location of parotid gland tumors in relation to the facial nerve using Stensen's duct.
METHODS
This is a retrospective cross-sectional study at a single institute. The subjects who underwent preoperative ultrasound and parotidectomy for parotid gland tumors were included. The subjects with incomplete operative records or no reference standard for the location of parotid gland tumor were excluded. The primary predictor was ultrasound tumor location, which was defined as the location of parotid gland tumors determined by preoperative ultrasound as to whether the tumors were superficial or deep to the facial nerve. The operative records were used as the reference standard for the location of parotid gland tumors. The primary outcome was diagnostic performances of preoperative ultrasound in predicting the location of parotid gland tumors, which were calculated by comparing ultrasound tumor location to the reference standard. Covariates were sex, age, type of surgery, tumor size, and tumor histology. Data analysis involved descriptive and analytic statistics; P < .05 was considered statistically significant.
RESULTS
One hundred and two of 140 eligible subjects met inclusion and exclusion criteria. There were 50 male and 52 female, with a mean age of 53.3 years. Ultrasound tumor location was classified as deep in 29 subjects, superficial in 50, and indeterminate in 23. The reference standard was deep in 32 subjects and superficial in 70. Indeterminate ultrasound tumor location results were grouped as either deep or superficial to make every possible cross table in which ultrasound tumor location results were presented as a dichotomy. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the ultrasound to predict the deep location of parotid tumors were 87.5, 82.1, 70.2, 93.6, and 83.8%, respectively.
CONCLUSIONS
Stensen's duct on ultrasound can be a useful criterion to determine the location of parotid gland tumor relative to the facial nerve.
Topics: Humans; Male; Female; Middle Aged; Parotid Neoplasms; Parotid Gland; Facial Nerve; Salivary Ducts; Retrospective Studies; Cross-Sectional Studies
PubMed: 37301226
DOI: 10.1016/j.joms.2023.05.012 -
Clinical and pathological analysis of 10 cases of salivary gland epithelial-myoepithelial carcinoma.Medicine Oct 2020Epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands. The aim of this study is to review and evaluate clinicopathological features and...
Epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands. The aim of this study is to review and evaluate clinicopathological features and treatment of EMC of salivary gland for better sensitivity and specificity of the diagnosis.The clinical and pathological data of the 10 salivary gland EMC cases from 2008 to 2017 were analyzed.Six cases of EMC were diagnosed to be originated from parotid gland and 4 cases were from the minor salivary gland including palate, tongue, and oropharynx. Seven cases were performed radical surgery and 3 cases had radiotherapy postoperation, 2 cases had a local recurrence. The follow-up period was 4 to 104 months and the survival rate was 100%. Histopathology showed the tumors had a dominant prototypical biphasic tubular structure consisting of inner, cuboidal ductal cells and an outer layer of clear, myoepithelial cells, which grew infiltratively. The immunohistochemistry (IHC) showed the marker proteins CK, S-100, CD117, and Calponin were strongly positive in most EMC.EMC is a rare and low-grade malignant tumor with good overall survival but relatively high tendency for local recurrence. Surgery is the priority choice for EMC therapy. Complete surgical excision and negative margins are necessary for good prognosis. Imaging techniques should be used to assess the neck dissection and it is unclear whether adjuvant radiotherapy is beneficial. To ensure the sensitivity and specificity of the EMC diagnosis, we should perform both pathological and IHC analysis.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Female; Humans; Male; Middle Aged; Myoepithelioma; Retrospective Studies; Salivary Gland Neoplasms; Salivary Glands
PubMed: 33031333
DOI: 10.1097/MD.0000000000022671