Title: Retrospective Analysis of Malignant Parotid Tumors and their Outcome: A Single Centre Study
Authors: Dr Yogesh Pawde, Dr Radhika Rai
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.192
Abstract
Aim: To assess the outcome of malignant parotid tumor cases operated in our institute and the lessons learnt.
Material & Methods: A retrospective observational study of 31 patients presenting with malignant parotid masses were analyzed over 2 years. Patients were investigated, diagnosed and staged according to AJCC 7th edition staging classication and the treatment modality selected on that basis. Postoperatively patients were assessed for complications like facial nerve palsy and Frey's syndrome etc. Patients were followed up every 3-6 monthly and their outcomes assessed.
Results & Discussion: Males comprised 61.29%. Most of the patients were in middle age group and main symptom was swelling at parotid site with an average duration of 2.5months. 19.5% of patients had facial palsy at the time of presentation and around 86% of them had high risk features with most of them developing metastasis.78% of patients presented in clinical stage 1 &2. All patients were treated with surgery. Elective neck dissection was done in 11 patients. The most common malignancy found was mucoepidermoid carcinoma (67%). Facial Palsy developed in 12 patients. A Total of 8 patients (25%) developed Freys syndrome which was managed conservatively. 18patients received PORT. The lowest mean disease free survival was seen in high grade mucoepidermoid cancer (9.1mths), while others had almost 2 years of disease free survival. 5 patients developed lung metastasis, With the Mean duration being 20.4 months.
Conclusion: Malignancies of the major salivary glands form a rare and diverse group of cancers. The extent of surgery is dictated by the stage of the tumour which can be supercial or total parotidectomy. LVI+, PNI+, facial nerve palsynd advanced stage are factors which indicate bad prognosis. Consideration should be given for neck dissection in N+ patients and in N0 neck, if associated with high risk features.
References
- Malignant salivary gland tumors: P.J Fitzpatrick, C Theriault, M.D International Journal of Radiation Oncology* Biology* Physics Volume 12, Issue 10, October 1986, P a g e s 1 7 4 3 – 1 7 4 7
- Malignant epithelial parotid gland tumours: analysis and results in 65 previously untreated patients .H. Leverstein et al. British Journal of Surgery, Volume 85, Issue 9, pages 1267–1272, September 1998.
- Kim TS, Lee KS, Han J et-al. Sialadenoid tumors of the respiratory tract: radiologic-pathologic correlation. AJR Am J Roentgenol. 2001;177 5):1145-50. AJR Am J Roentgenol (full text) -Pubmed citation
- Parotid cancer treatment with surgery followed by radiotherapy in Oxford over 15 years -Ketan Shah1, Faisal Javed2, Chris Alcock1, Ketan A Shah2, Pieter Pretorius2, Chris A Milford2 : Ann R CollSurgEngl 2011; 93: 218–222
- Frey's syndrome: prevention with conservative parotidectomy and supercial musculoaponeurotic system preservation. Yu LT1, Hamilton R. Ann Plast Surg. 1992 Sep;29(3):217-22.
- Clinical Prognostic Factors in Malignant Parotid Gland Tumors Roberto A. Lima, MD1,Marcos R. Tavares, MD3,Fernando L. Dias, MD1 Otolaryngol head and neck surgery ,November 2005 vol133 no 5702-708.
- Malignant parotid tumors in 110 consecutive patients: Treatment results and prognosis: Dorte Pedersen MD et al The Laryngoscope Volume 102, Issue 9, pages 1064–1069, September 1992.
- Prognostic Variables in Parotid Gland Cancer Robert A. Frankenthaler, MD; Mario A. Luna, MD; Sang Sook Lee, MD; Kie-Kian Ang, MD, PhD; Robert M. Byers, MD; Oscar M. Guillamondegui, MD; Pat Wolf; Helmuth Goepfert, MD Arch Otolaryngol Head Neck Surg. 1991;117(11):1251-1256. doi:10.1001/archotol.1991.01870230067009.
- Clinicopathological and treatment related factors inuencing survival in malignant parotid cancers A G Renehan,1 E N Gleave, 1 N J Slevin, 2 and M McGurk3.