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BMC Cancer May 2024The study aimed to assess the impact of parotid lymph nodes (LNs) on the prognosis of patients with cutaneous squamous cell carcinomas of the head and neck (HNcSCC), and...
BACKGROUND
The study aimed to assess the impact of parotid lymph nodes (LNs) on the prognosis of patients with cutaneous squamous cell carcinomas of the head and neck (HNcSCC), and to develop an alternative LN assessment method to enhance locoregional control (LRC) and overall survival (OS) stratification.
METHODS
We retrospectively enrolled patients with surgically treated HNcSCC. Primary outcome variables were LRC and OS. The influence of parotid LNs and different LN assessment methods on prognosis was analyzed using Cox models, and comparisons were made using the C-index, Akaike Information Criterion, and Bayesian Information Criterion.
RESULTS
A total of 126 patients were included. Both intraparotid and periparotid LN statuses significantly linked with prognosis. The presence of extranodal extension (ENE) in cervical LNs, rather than parotid LNs, was predictive of decreased LRC and OS. In the Cox analysis, only N3 of the AJCC N classification, when compared to N0, showed reduced LRC and OS. In comparison to N0P1, only N0P3/N1P1 and N2P2/N2P3 of the O'Brien staging system tended to predict poorer LRC, with no subgroup emerging as an independent predictor for OS. The proposed LN assessment method, based on the number of metastatic LNs and ENE status in cervical LNs, demonstrated superior performance in terms of C-index, Akaike Information Criterion, and Bayesian Information Criterion compared to other systems.
CONCLUSION
Parotid LNs were significant determinants of prognosis in metastatic HNcSCC. The novel LN assessment method proposed (1-2 vs. 3-4 vs. 5 + or ENE) displayed similar survival stratification to the AJCC N and O'Brien staging systems.
Topics: Humans; Male; Female; Lymphatic Metastasis; Aged; Middle Aged; Retrospective Studies; Skin Neoplasms; Lymph Nodes; Prognosis; Head and Neck Neoplasms; Squamous Cell Carcinoma of Head and Neck; Neoplasm Staging; Adult; Aged, 80 and over; Carcinoma, Squamous Cell
PubMed: 38811899
DOI: 10.1186/s12885-024-12384-6 -
Otolaryngologia Polska = the Polish... Jun 2024<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of...
<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>.
Topics: Humans; Parotid Neoplasms; Male; Female; Middle Aged; Retrospective Studies; Aged; Adult; Radiotherapy, Adjuvant; Treatment Outcome; Neoplasm Staging; Prognosis; Aged, 80 and over
PubMed: 38808641
DOI: No ID Found -
BMC Cancer May 2024This study aimed to assess the long-term effect of level IIb clinical target volume (CTV) optimisation on survival, xerostomia, and dysphagia in patients with...
Long-term follow-up of protective effects on salivary and swallowing structures and improvement of late xerostomia and dysphagia by level IIb optimisation in clinical target volume of nasopharyngeal carcinoma.
BACKGROUND
This study aimed to assess the long-term effect of level IIb clinical target volume (CTV) optimisation on survival, xerostomia, and dysphagia in patients with nasopharyngeal carcinoma (NPC).
METHODS
Clinical data of 415 patients with NPC treated with intensity-modulated radiotherapy between December 2014 and October 2018 were retrospectively analysed. The patients were categorised into modified and comparison groups. Late xerostomia and dysphagia were evaluated using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer scoring. Survival analysis was performed using the Kaplan-Meier method. Differences in late toxicity and dose parameters between both groups were compared. Prognostic factors for survival and late toxicity were assessed using regression analyses.
RESULTS
Patients in the modified group developed late xerostomia and dysphagia less frequently than those in the comparison group did (P < 0.001). The mean dose (D) and V of parotid glands; D and V of submandibular glands; and D of sublingual glands, oral cavity, larynx, and superior, middle, and lower pharyngeal constrictor muscles were lower in the modified group than those in the comparison group (all P < 0.001). Both groups had no significant differences in overall, local recurrence-free, distant metastasis-free, or progression-free survival. The D of the parotid and sublingual glands was a risk factor for xerostomia. The D of the parotid and sublingual glands and middle pharyngeal constrictor muscle was a risk factor for dysphagia.
CONCLUSIONS
Level IIb optimisation in NPC patients who meet certain criteria specially the exclusion of positive retropharyngeal nodes treated with intensity-modulated radiotherapy has the potential to better protect the salivary and swallowing structures, decreasing the development of late radiation-induced xerostomia and dysphagia while maintaining long-term survival.
Topics: Humans; Deglutition Disorders; Male; Xerostomia; Female; Nasopharyngeal Carcinoma; Middle Aged; Radiotherapy, Intensity-Modulated; Retrospective Studies; Follow-Up Studies; Nasopharyngeal Neoplasms; Adult; Aged; Radiation Injuries; Deglutition; Salivary Glands; Radiotherapy Dosage; Prognosis; Young Adult
PubMed: 38802747
DOI: 10.1186/s12885-024-12391-7 -
Technology in Cancer Research &... 2024This prospective study aims to evaluate acute irradiation-induced xerostomia during radiotherapy by utilizing the normalized iodine concentration (NIC) derived from...
This prospective study aims to evaluate acute irradiation-induced xerostomia during radiotherapy by utilizing the normalized iodine concentration (NIC) derived from energy spectrum computed tomography (CT) iodine maps. In this prospective study, we evaluated 28 patients diagnosed with nasopharyngeal carcinoma. At 4 distinct stages of radiotherapy (0, 10, 20, and 30 fractions), each patient underwent CT scans to generate iodine maps. The NIC of both the left and right parotid glands was obtained, with the NIC at the 0-fraction stage serving as the baseline measurement. After statistically comparing the NIC obtained in the arterial phase, early venous phase, late venous phase, and delayed phase, we chose the late venous iodine concentration as the NIC and proceeded to analyze the variations in NIC at each radiotherapy interval. Using the series of NIC values, we conducted hypothesis tests to evaluate the extent of change in NIC within the parotid gland across different stages. Furthermore, we identified the specific time point at which the NIC decay exhibited the most statistically significant results. In addition, we evaluated the xerostomia grades of the patients at these 4 stages, following the radiation therapy oncology group (RTOG) xerostomia evaluation standard, to draw comparisons with the changes observed in NIC. The NIC in the late venous phase exhibited the highest level of statistical significance ( < .001). There was a noticeable attenuation in NIC as the RTOG dry mouth grade increased. Particularly, at the 20 fraction, the NIC experienced the most substantial attenuation ( < .001), a significant negative correlation was observed between the NIC of the left, right, and both parotid glands, and the RTOG evaluation grade of acute irradiation-induced xerostomia ( < .001, = -0.46; < .001, = -0.45; < .001, = -0.47). The critical NIC values for the left, right, and both parotid glands when acute xerostomia occurred were 0.175, 0.185, and 0.345 mg/ml, respectively, with AUC = 0.73, AUC = 0.75, and AUC = 0.75. The NIC may be used to evaluate changes in parotid gland function during radiotherapy and acute irradiation-induced xerostomia.
Topics: Humans; Xerostomia; Male; Parotid Gland; Female; Nasopharyngeal Carcinoma; Middle Aged; Adult; Tomography, X-Ray Computed; Aged; Nasopharyngeal Neoplasms; Iodine; Prospective Studies; Radiation Injuries; Radiotherapy Dosage
PubMed: 38773777
DOI: 10.1177/15330338241256814 -
BMC Oral Health May 2024Lymph node (LN) status is an important prognostic factor for parotid gland cancer (PGC). This study aimed to analyze the impact of extranodal extension (ENE) of...
BACKGROUND
Lymph node (LN) status is an important prognostic factor for parotid gland cancer (PGC). This study aimed to analyze the impact of extranodal extension (ENE) of intraparotid LN and LN metastasis burden on survival in PGC.
METHODS
Patients with surgically treated PGC and at least one metastatic cervical LN were retrospectively enrolled. Primary outcome variables were distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS). The impact of ENE and LN metastasis burden was assessed using the Cox model.
RESULTS
A total of 292 patients were included. ENE in cervical or intraparotid LN was not associated with DMFS, DSS, or OS. Intraparotid LN metastasis had a significant impact on prognosis, and the presence of only one metastatic intraparotid LN offered an approximately 1.5-fold risk of distant metastasis. Prognostic models based on the number of positive LNs (1 vs. 2-3 vs. 4+) were superior to the AJCC N stage in terms of DMFS, DSS, and OS.
CONCLUSIONS
ENE of cervical or intraparotid LN has a limited effect on the prognosis of PGC, and the number of positive LNs is better than the AJCC N stage in LN status evaluation.
Topics: Humans; Parotid Neoplasms; Male; Female; Middle Aged; Lymphatic Metastasis; Neoplasm Staging; Retrospective Studies; Lymph Nodes; Aged; Prognosis; Adult; Extranodal Extension; Survival Rate; Aged, 80 and over; Disease-Free Survival; Neck
PubMed: 38773438
DOI: 10.1186/s12903-024-04346-y -
Prague Medical Report 2024Salivary gland neoplasms account for 3% of all head and neck tumours. Pleomorphic adenoma (PA) is the most common salivary gland tumour that mainly occurs in the parotid...
Salivary gland neoplasms account for 3% of all head and neck tumours. Pleomorphic adenoma (PA) is the most common salivary gland tumour that mainly occurs in the parotid gland, followed by minor salivary glands of the oral cavity, however, the occurrence of PA inside the jaw bones is exceedingly rare and very few cases have been reported in the literature. Inside jaw bones these lesions tend to imitate large osteolytic lesions encompass a diagnostic challenge. An exhaustive review of the literature revealed only 10 cases of central pleomorphic adenoma. We present a rare case of primary PA that occurred inside the mandible and was provisionally diagnosed as ameloblastoma.
Topics: Humans; Ameloblastoma; Adenoma, Pleomorphic; Mandibular Neoplasms; Diagnosis, Differential; Male; Female
PubMed: 38761048
DOI: 10.14712/23362936.2024.14 -
Cureus Apr 2024Primary tuberculous parotitis is an extremely rare entity presenting with nonspecific symptoms, variable clinical signs, and imaging features mimicking parotid...
Primary tuberculous parotitis is an extremely rare entity presenting with nonspecific symptoms, variable clinical signs, and imaging features mimicking parotid neoplasm. It is a clinical and diagnostic challenge, and a confirmed histological diagnosis would indicate nonoperative management, thus avoiding unwarranted surgery and associated morbidity. Tuberculosis of the salivary gland is a relatively rare extrapulmonary manifestation of tuberculosis, with the incidence of tuberculous parotitis being 2%-9%. The prevalence of disseminated tuberculosis has increased in recent times because of the use of immunosuppressive therapy for organ transplantation and chemotherapy. However, the incidence of concurrent pulmonary tuberculosis in patients with tuberculous parotitis is a rarer scenario. Fine-needle aspiration cytology (FNAC) can confirm the diagnosis of tuberculous parotitis with a high sensitivity (84%-100%) and specificity (94%-100%). The utility of FNAC is also enhanced as the aspirate can be utilized for cartridge-based nucleic acid amplification test (CBNAAT) testing for mycobacterium and drug sensitivity testing, thereby further increasing its sensitivity and specificity. This translates to a lesser chance of unnecessary surgical intervention and the potential surgical morbidity. Here, we report a case of parotid swelling in a 72-year-old male, with no evidence of any pulmonary or systemic tuberculosis, with clinical and imaging features suggestive of parotid neoplasm but diagnosed as tubercular parotitis on FNAC. He was started on antitubercular therapy, which resulted in the progressive diminution of the size of the lesion. Primary tuberculous parotitis should be considered a possibility while managing the parotid neoplasm.
PubMed: 38745804
DOI: 10.7759/cureus.58217 -
Scientific Reports May 2024Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types.... (Observational Study)
Observational Study
Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types. Multispectral optoacoustic tomography (MSOT) may improve the preoperative diagnostics. In this first prospective pilot trial the ability of MSOT to discriminate between the two most frequent benign parotid tumors, pleomorphic adenoma (PA) and Warthin tumor (WT) as well as to normal parotid tissue was explored. Six wavelengths (700, 730, 760, 800, 850, 900 nm) and the parameters deoxygenated (HbR), oxygenated (HbO), total hemoglobin (HbT), and saturation of hemoglobin (sO) were analyzed. Ten patients with PA and fourteen with WT were included (12/12 female/male; median age: 51 years). For PA, the mean values for all measured wave lengths as well as for the hemoglobin parameters were different for the tumors compared to the healthy parotid (all p < 0.05). The mean MSOT parameters were all significantly higher (all p < 0.05) in the WT compared to healthy parotid gland except for HbT and sO. Comparing both tumors directly, the mean values of MSOT parameters were not different between PA and WT (all p > 0.05). Differences were seen for the maximal MSOT parameters. The maximal tumor values for 900 nm, HbR, HbT, and sO were lower in PA than in WT (all p < 0.05). This preliminary MSOT parotid tumor imaging study showed clear differences for PA or WT compared to healthy parotid tissue. Some MSOT characteristics of PA and WT were different but needed to be explored in larger studies.
Topics: Humans; Female; Parotid Neoplasms; Middle Aged; Male; Pilot Projects; Prospective Studies; Photoacoustic Techniques; Adult; Aged; Hemoglobins; Adenolymphoma; Adenoma, Pleomorphic; Tomography; Parotid Gland
PubMed: 38719924
DOI: 10.1038/s41598-024-61303-z -
Cancer Diagnosis & Prognosis 2024The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland...
BACKGROUND/AIM
The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland are relatively rare, with 80% being benign and 20% malignant, primarily represented by mucoepidermoid carcinoma. In the head and neck region, lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant salivary gland tumors.
CASE REPORT
A 35-year-old man with no previous comorbidities was admitted to a Head and Neck Surgery Specialty Service for a painless right cervical mass of uncertain growth. Extensive diagnostic investigation revealed involvement of the contralateral parotid, associated with systemic lymph node enlargement. Thus, adjuvant radiotherapy was decided by the treating team.
CONCLUSION
This case confirms the heterogeneous features and distinctive behavior that the disease can present, as seen with bilateral parotid LEC.
PubMed: 38707721
DOI: 10.21873/cdp.10336 -
Journal of Medical Case Reports May 2024Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have... (Review)
Review
BACKGROUND
Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting.
CASE PRESENTATION
A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma.
CONCLUSIONS
Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.
Topics: Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Magnetic Resonance Imaging; Lymphoma
PubMed: 38698413
DOI: 10.1186/s13256-024-04553-9