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Journal of the European Academy of... Sep 2021Although adjuvant radiotherapy has been used for cutaneous squamous cell carcinoma, its outcome benefits, especially for patients with clear surgical margins, have not... (Meta-Analysis)
Meta-Analysis Review
Although adjuvant radiotherapy has been used for cutaneous squamous cell carcinoma, its outcome benefits, especially for patients with clear surgical margins, have not been statistically estimated, and the characteristics that can indicate patients who require adjuvant therapy need to be validated with more evidence. We conducted a systematic review and meta-analysis of literature on the survival outcomes and prognostic factors in patients with cSCC treated by surgery with or without adjuvant radiotherapy. Twenty related studies involving 2605 patients met our inclusion criteria. The significant survival outcomes of adjuvant radiotherapy included lower recurrence (OR, 0.56; 95% CI, 0.36-0.85), longer disease-free survival (OR, 2.17; 95% CI, 1.23-3.83) and longer overall survival (OR, 2.94; 95% CI, 1.75-4.91). Significant prognostic factors for poor outcomes were perineural invasion (HR, 1.61; 95% CI, 1.24-2.09), involved surgical margins (HR, 2.34; 95% CI, 1.42-3.83) and immunosuppression (HR, 3.02; 95% CI, 2.14-4.25) while adjuvant radiotherapy significantly contributed to better overall survival (HR, 0.47; 95% CI, 0.34-0.65). In conclusion, this systematic review suggests that in cutaneous squamous cell carcinoma patients with risk factors, including metastasis to the parotid gland, perineural invasion and immunosuppression, the use of adjuvant radiotherapy may be beneficial irrespective of surgical margin status.
Topics: Carcinoma, Squamous Cell; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Radiotherapy, Adjuvant; Retrospective Studies; Skin Neoplasms
PubMed: 33930213
DOI: 10.1111/jdv.17330 -
Head & Neck Apr 2019Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck,... (Meta-Analysis)
Meta-Analysis
Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck, there is debate about the role of elective neck dissection (END), irradiation or observation. This systematic review assesses the prevalence of occult cervical disease and the evidence for END. A literature search was performed using Medline and Embase. All papers describing management of the neck in metastatic CSCC to the parotid were assessed for inclusion. Eighty-nine papers were identified and 17 met inclusion criteria. A total of 874 ENDs were performed in 874 patients with metastatic CSCC to the parotid with no clinically evident cervical disease. The overall prevalence of occult disease in a random effects model was 22.5% (95% confidence intervals 18.9-26.0). The prevalence of occult cervical disease in metastatic CSCC to the parotid is high. END is recommended in this patient group.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Elective Surgical Procedures; Female; Humans; Male; Neck Dissection; Neoplasm Invasiveness; Neoplasm Staging; Parotid Neoplasms; Prognosis; Skin Neoplasms; Survival Rate
PubMed: 30536662
DOI: 10.1002/hed.25561 -
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 -
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 -
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 -
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 -
The Journal of Laryngology and Otology May 2024Warthin's tumours are the second most common benign parotid tumours in the UK. The World Health Organization states that 5-14 per cent of patients have bilateral...
OBJECTIVE
Warthin's tumours are the second most common benign parotid tumours in the UK. The World Health Organization states that 5-14 per cent of patients have bilateral Warthin's tumours. This study aimed to: assess the presence of contralateral Warthin's tumours in patients who underwent surgery over the past 16 years at a head and neck unit in England, and perform the first systematic literature review on bilateral Warthin's tumours.
METHODS
A retrospective analysis was conducted on patients diagnosed with Warthin's tumour based on histology between 2005 and 2020. Additionally, a systematic review (International Prospective Register of Systematic Reviews ('PROSPERO') registration number: CRD42022326846) was performed using PubMed and the Cochrane Library.
RESULTS
Among 290 patients diagnosed with Warthin's tumours based on histology following surgery, 24.5 per cent had bilateral Warthin's tumours. The systematic review identified 157 papers, with 14 meeting the inclusion criteria.
CONCLUSION
This study revealed that 24.5 per cent of patients had bilateral Warthin's tumours, deviating from the suggested range. These findings are of interest to surgeons discussing the disease with patients.
Topics: Humans; Adenolymphoma; Parotid Neoplasms; Retrospective Studies; Female; Male; England; Middle Aged; Aged; Parotid Gland
PubMed: 37920099
DOI: 10.1017/S0022215123001834 -
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 -
Clinical Imaging 2018To assess the added benefit of combining different MRI techniques for preoperative diagnosis of parotid tumors when compared to conventional MRI and advanced MRI... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the added benefit of combining different MRI techniques for preoperative diagnosis of parotid tumors when compared to conventional MRI and advanced MRI techniques alone with meta-analysis.
METHODS
A comprehensive PubMed electronic database search was performed for original diagnostic studies up to July 2017. The methodologic quality of each study was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Statistical analysis included pooling of sensitivity and specificity with 95% confidence intervals (CI). All analyses were conducted using STATA (version 12.0), RevMan (version 5.2), and Meta-Disc 1.4 software programs.
RESULTS
Pooled sensitivity and specificity of conventional MRI, diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and the above combination were 76% (95%CI)/91% (95%CI)/80% (95%CI)/86% (95%CI) and 83% (95%CI)/56% (95%CI)/90% (95%CI)/90% (95%CI).
CONCLUSION
Conventional MRI combined with DWI and DCE showed higher diagnostic accuracy than conventional or advanced MRI alone, supporting their use in parotid tumors diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Contrast Media; Databases, Factual; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Parotid Neoplasms; Sensitivity and Specificity; Software; Young Adult
PubMed: 29908348
DOI: 10.1016/j.clinimag.2018.05.026