A Case of Multiple Intracranial Hemorrhages due to a Ruptured Neoplastic Cerebral Aneurysm Secondary to Metastasis of Poorly Differentiated Parotid Gland Carcinoma.

Neoplastic cerebral aneurysms (NCAs) are rare. This study reported a case of an NCA secondary to a poorly differentiated carcinoma of the parotid gland. An 84-year-old Japanese woman undergoing treatment for parotid gland cancer was admitted to our hospital with headache and progressive loss of consciousness. Based on computed tomography (CT) and CT angiography (CTA), a diagnosis of subarachnoid hemorrhage due to rupture of a left posterior inferior cerebellar artery aneurysm was made, and emergency aneurysmectomy was performed. Pathological examination of the resected aneurysm showed an NCA secondary to parotid carcinoma. After the aneurysmectomy, her condition stabilized; however, 33 days later, the patient developed an intracerebral hemorrhage, and a new aneurysm was confirmed in the right middle cerebral artery. To the best of our knowledge, there have been no previous reports on cases of NCAs secondary to parotid carcinoma. The pathology and clinical course strongly suggest that NCAs derived from malignant tumors may have an aggressive course.

Nomogram based on immune-inflammatory indicators and age-adjusted charlson comorbidity index score to predict prognosis of postoperative parotid gland carcinoma patients.

BACKGROUND: Parotid gland carcinoma (PGC) is a rare malignant tumor. The purpose of this study was to investigate the role of immune-inflammatory-nutrition indicators and age-adjusted Charlson comorbidity index score (ACCI) of PGC and develop the nomogram model for predicting prognosis. METHOD: All patients diagnosed with PGC in two tertiary hospitals, treated with surgical resection, from March 2012 to June 2018 were obtained. Potential prognostic factors were identified by univariate and multivariate Cox regression analyses. The nomogram models were established based on these identified independent prognostic factors. The performance of the developed prognostic model was estimated by related indexes and plots. RESULT: The study population consisted of 344 patients with PGC who underwent surgical resection, 285 patients without smoking (82.8%), and 225 patients (65.4%) with mucoepidermoid carcinoma, with a median age of 50.0 years. American Joint Committee on Cancer (AJCC) stage (p < 0.001), pathology (p = 0.019), tumor location (p < 0.001), extranodal extension (ENE) (p < 0.001), systemic immune-inflammation index (SII) (p = 0.004), prognostic nutrition index (PNI) (p = 0.003), ACCI (p < 0.001), and Glasgow prognostic Score (GPS) (p = 0.001) were independent indicators for disease free survival (DFS). Additionally, the independent prognostic factors for overall survival (OS) including AJCC stage (p = 0.015), pathology (p = 0.004), tumor location (p < 0.001), perineural invasion (p = 0.009), ENE (p < 0.001), systemic immune-inflammation index (SII) (p = 0.001), PNI (p = 0.001), ACCI (p = 0.003), and GPS (p = 0.033). The nomogram models for predicting DFS and OS in PGC patients were generated based on these independent risk factors. All nomogram models show good discriminative capability with area under curves (AUCs) over 0.8 (DFS 0.802, and OS 0.825, respectively). Decision curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification index (NRI) show good clinical net benefit of the two nomograms in both training and validation cohorts. Kaplan-Meier survival analyses showed superior discrimination of DFS and OS in the new risk stratification system compared with the AJCC stage system. Finally, postoperative patients with PGC who underwent adjuvant radiotherapy had a better prognosis in the high-, and medium-risk subgroups (p < 0.05), but not for the low-risk subgroup. CONCLUSION: The immune-inflammatory-nutrition indicators and ACCI played an important role in both DFS and OS of PGC patients. Adjuvant radiotherapy had no benefit in the low-risk subgroup for PGC patients who underwent surgical resection. The newly established nomogram models perform well and can provide an individualized prognostic reference, which may be helpful for patients and surgeons in proper follow-up strategies.

A novel postoperative nomogram and risk classification system for individualized estimation of survival among patients with parotid gland carcinoma after surgery.

BACKGROUND: Parotid gland carcinoma (PGC) is a rare but aggressive head and neck cancer, and the prognostic model associated with survival after surgical resection has not yet been established. This study aimed to construct a novel postoperative nomogram and risk classification system for the individualized prediction of overall survival (OS) among patients with resected PGC. METHODS: Patients with PGC who underwent surgery between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were randomized into training and validation cohorts (7:3). A nomogram developed using independent prognostic factors based on the results of the multivariate Cox regression analysis. Harrell's concordance index (C-index), time-dependent area under the curve (AUC), and calibration plots were used to validate the performance of the nomogram. Moreover, decision curve analysis (DCA) was performed to compare the clinical use of the nomogram with that of traditional TNM staging. RESULTS: In this study, 5077 patients who underwent surgery for PGC were included. Age, sex, marital status, tumor grade, histology, TNM stage, surgery type, radiotherapy, and chemotherapy were independent prognostic factors. Based on these independent factors, a postoperative nomogram was developed. The C-index of the proposed nomogram was 0.807 (95% confidence interval 0.797-0.817). Meanwhile, the time-dependent AUC (> 0.8) indicated that the nomogram had a satisfactory discriminative ability. The calibration curves showed good concordance between the predicted and actual probabilities of OS, and DCA curves indicated that the nomogram had a better clinical application value than the traditional TNM staging. Moreover, a risk classification system was built that could perfectly classify patients with PGC into three risk groups. CONCLUSIONS: This study constructed a novel postoperative nomogram and corresponding risk classification system to predict the OS of patients with PGC after surgery. These tools can be used to stratify patients with high or low risk of mortality and provide high-risk patients with more directed therapies and closer follow-up.

Metastasis of spine from adenoid cystic carcinoma of the parotid gland: two case reports.

BACKGROUND: Spinal metastasis from adenoid cystic carcinoma of the salivary gland is extremely rare. We present two interesting cases of spinal metastasis from adenoid cystic carcinoma of the parotid gland. A 29-year-old Persian male and a 48-year-old Persian female presented with parotid gland mass. The two patients received parotidectomy and radiotherapy. The pathological examination result was adenoid cystic carcinoma. Because of intractable back pain, patients were referred to the hospital after 7 years and 9 months, respectively. Both cases underwent spinal surgery. Histopathology confirmed spinal metastasis from adenoid cystic carcinoma of the parotid gland (case 1: T6, T12, and L1; case 2: T12). Anterior corpectomy of T12 and lateral screw fixation at T11 and L1 were done in case 2. Posterior spinal fusions from T2 to L3 and from T10 to L2 were performed in case 1 and case 2, respectively. Both patients showed good clinical improvement. The last follow-up (case 1: 24 months; case 2: 6 months after surgery), plain radiographs and computed tomography scan showed good fusion without instrumental failure and magnetic resonance imaging revealed good decompression of the spinal cord of both cases. CONCLUSION: Although spinal metastasis from adenoid cystic carcinoma of the parotid gland is extremely rare, it is necessary to be careful in the differential diagnosis.

NUT carcinoma of the parotid gland: report of two cases, one with a rare ZNF532-NUTM1 fusion.

Nuclear protein in testis (NUT) carcinoma (NC) is a rare aggressive tumor with a typical NUTM1 gene rearrangement. Herein, we aimed to investigate the morphological and genetic features of head and neck NC. Immunohistochemistry staining for NUT (C52B1) was performed for 118 samples of head and neck poorly differentiated/undifferentiated carcinoma. Diffuse NUT staining was further confirmed via fluorescence in situ hybridization and next-generation sequencing. Two parotid gland NC cases, one in a 22-year-old man and one in a 52-year-old woman, were confirmed (2/118, 1.6%). Typical morphological features, including squamous cells and abrupt keratinization, were observed. Diffuse pankeratin, CK5/6, p63, and MYC expression were noted, while CD34, CD99, synaptophysin, chromogranin A, TTF1, S-100, and PD-L1 staining and EBER in situ hybridization (EBV-ISH) were negative. Both tumors harbored a NUTM1 rearrangement: a classic BRD4-NUTM1 fusion and a rare ZNF532-NUTM1 fusion. Furthermore, trisomy 8 and three copies of the MYC gene were detected in both cases. Next-generation sequencing revealed six additional somatic alterations, a low tumor mutation burden, and microsatellite stability. Patient 1 died from the disease after 15 months, and patient 2 was alive after 8 months. Parotid gland NC exhibits diverse morphological features and heterogeneous genotypes. To the best of our knowledge, this is the first report of parotid gland NC with a ZNF532-NUTM1 fusion.

[Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma].

OBJECTIVE: To investigate the effectiveness of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma (PGC). METHODS: Between June 2010 and June 2020, 32 patients with advanced local lesions of PGC were treated with extended radical resection. After that, 17 patients were repaired with the free peroneal artery chimeric perforator flaps (trial group) and another 15 patients were repaired with the pedicled pectoralis major myocutaneous flaps (control group). There was no significant difference in gender, age, disease type, histopathological classification, clinical stage, and pathological stage between groups ( P>0.05). The size of skin flap in trial group ranged from 7 cm×6 cm to 12 cm×8 cm and the size of soleus muscle flap ranged from 5 cm×3 cm to 6 cm×4 cm. The donor sites were repaired with skin grafting. The size of the pedicled pectoralis major myocutaneous flaps in control group ranged from 9 cm×6 cm to 14 cm×7 cm. The donor sites were sutured directly. The operation time, survival rate of flap, and postoperative survival of patients were recorded and compared between groups. At 1 year after operation, the University of Washington quality of life (UW-QOL) questionnaire was used to evaluate the quality of life of patients in the two groups, including appearance, shoulder movement, sociability, masticatory function, speech function, and mood. RESULTS: The operations completed successfully. The operation time was (6.19±0.72) hours in trial group and (6.41±0.71) hours in control group, showing no significant difference between groups ( t=-0.863, P=0.395). The survival rate of flap in trial group was 94.1% (16/17); and 1 patient suffered from vascular crisis after operation and was replaced with the pedicled pectoralis major myocutaneous flap. The survival rate of flap in control group was 100%. All grafts survived and the incisions healed by first intention in the two groups. All patients were followed up. The follow-up time was 6-60 months (median, 60 months) in trial group and 7-60 months (median, 60 months) in control group. Cumulative survival rates of patients at 1, 3, and 5 years after operation were 94.1%, 64.7%, and 58.8% in trial group, respectively; 86.7%, 66.7%, and 53.3% in control group, respectively. There was no significant difference in the cumulative survival rate between groups ( χ 2=0.090, P=0.762). According to the UW-QOL questionnaire at 1 year after operation, the scores of appearance, shoulder movement, sociability, and mood in trial group were significantly higher than those in control group ( P<0.05); and there was no significant difference in masticatory function and speech function scores between groups ( P>0.05). CONCLUSION: The peroneal artery perforator has an invariable anatomical relationship. Each perforator emits the muscular branch that nourishes the soleus muscle. Therefore, personalized free peroneal artery chimeric perforator flap can be designed according to the tissue defect, and used to repair the defect after advanced local lesions resection in PGC.

Pretherapeutic Predictive Factors for Histological High-Grade Parotid Gland Carcinoma.

OBJECTIVE: The histological grade of parotid gland carcinoma (PGC) is an important prognostic factor; however, the diagnosis prior to treatment has been challenging to make. This study aimed to investigate whether the pretreatment clinical findings, including hematological inflammatory, nutritional, and immune markers, could predict the histological grade of PGC. STUDY DESIGN: Retrospective study. METHODS: We retrospectively enrolled 111 patients with PGC and evaluated the correlation between histological grade and pretreatment clinical findings such as age, sex, tumor staging, facial nerve paralysis, pain or tenderness, adhesion to the surrounding tissues or tumor immobility, and hematological markers. RESULTS: Sixty patients (54%) were diagnosed with histological high-grade PGC. Univariate analysis revealed that age, T classification, N classification, TNM stage, facial nerve paralysis, adhesion/immobility, C-reactive protein (CRP), and CRP-to-albumin ratio (CAR) were significant predictors of PGC histological grade. On multivariate analysis, high T classification (T3, 4), high N classification (≥1), and elevated CRP (≥0.22 mg/dL) were independent predictors of high-grade PGC. CONCLUSIONS: Pretreatment T classification, N classification, and CRP are significant predictors of the histological grading of PGC. Our results are useful for treatment planning and obtaining appropriate informed consent from the patients before treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:96-102, 2022.

Predicting cancer-specific mortality in patients with parotid gland carcinoma by competing risk nomogram.

BACKGROUND: The aim of the present study was to establish a competing risk nomogram to predict parotid gland cancer-specific mortality (PGC-SM). METHODS: Seven thousand nine hundred and sixty-two patients extracted from SEER database were randomly categorized into training and validation sets. The competing risk model was used to identify factors associated with PGC-SM. The nomogram was evaluated via concordance indexes (C-indexes), calibration plots, and decision curve analysis (DCA). RESULTS: Male, elderly, white, widowed, larger tumor, no surgery, advanced tumor grade, lymph node (LN) metastasis, adenocarcinoma (ADC), and higher TNM stage were associated with higher incidence of PGC-SM. Calibration plots showed that the nomogram was well calibrated. C-indexes for nomogram were 0.84 (95% CI: 0.81-0.86) and 0.84 (95% CI: 0.82-0.86) in training and validation sets, respectively. DCA demonstrated the clinical usefulness of nomogram. CONCLUSIONS: The competing risk nomogram shows high performance in predicting PGC-SM, which might enable clinicians formulate suitable treatment protocols for patients with parotid gland carcinoma (PGC).

A Parsimonious Prognostic Model and Heat Map for Predicting Survival Following Adjuvant Radiotherapy in Parotid Gland Carcinoma With Lymph Node Metastasis.

OBJECTIVES: To construct a simplified prognostic risk model to predict overall survival after adjuvant radiotherapy for parotid gland carcinoma patients with stage T1-4aN1-3M0. MATERIALS AND METHODS: We evaluated 879 patients who were pathological diagnosed as stage T1-4aN1-3M0 parotid gland cancer. Those eligible patients treated with parotidectomy and neck lymph node dissection between 2004 and 2015 in the Surveillance Epidemiology and End Results database. All cases received adjuvant radiotherapy. Independent prognostic factors included in the original model were identified by Cox regression analysis. The primary endpoint was overall survival. The model's prediction power was evaluated by the concordance index. The entire cohort was categorized into new low- and high-risk groups using X-tile software according to the results of prognostic model. Kaplan-Meier method was used to depict the survival curves. And the statistical significance was determined by log-rank test. Besides, a heat map was visually described the association between the survival time and 2 most significant prognostic factors. RESULTS: In the univariable and multivariate analyses, 4 independent factors for overall survival were age, tumor size, pTNM stage, and the number of positive lymph nodes, which were all selected in the parsimonious prognostic model. The concordance indices of the prognostic model and pTNM stage were 0.652 and 0.565, respectively. Patients in the low-risk group had better overall survival over patients in the high-risk group [unadjusted hazard ratio = 2.578, 95% confidence interval 2.095-3.172, P < 0.001]. The results of the heat map revealed that patients with smaller tumor size and fewer positive lymph nodes had much longer survival time. CONCLUSIONS: This parsimonious prognostic model could estimate the long-term survival after adjuvant radiotherapy for parotid gland carcinoma with stage T1-4aN1-3N0M0. The tools may be valuable to guide multidisciplinary team in making treatment decisions.

Competing-risks nomograms for predicting cause-specific mortality in parotid-gland carcinoma: A population-based analysis.

INTRODUCTION: Parotid-gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing-risks analysis to PGC patients, and then established and validated predictive nomograms for PGC. METHODS: Specific screening criteria were applied to identify PGC patients and extract their clinical and other characteristics from the SEER database. We used the cumulative incidence function to estimate the cumulative incidence rates of PGC-specific death (GCD) and other cause-specific death (OCD), and tested for differences between groups using Gray's test. We then identified independent prognostic factors by applying the Fine-Gray proportional subdistribution hazard approach, and constructed predictive nomograms based on the results. Calibration curves and the concordance index (C-index) were employed to validate the nomograms. RESULTS: We finally identified 4,075 eligible PGC patients who had been added to the SEER database from 2004 to 2015. Their 1-, 3-, and 5-year cumulative incidence rates of GCD were 10.1%, 21.6%, and 25.7%, respectively, while those of OCD were 2.9%, 6.6%, and 9.0%. Age, race, World Health Organization histologic risk classification, differentiation grade, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, AJCC M stage, and RS (radiotherapy and surgery status) were independent predictors of GCD, while those of OCD were age, sex, marital status, AJCC T stage, AJCC M stage, and RS. These factors were integrated for constructing predictive nomograms. The results for calibration curves and the C-index suggested that the nomograms were well calibrated and had good discrimination ability. CONCLUSION: We have used the SEER database to establish-to the best of our knowledge-the first competing-risks nomograms for predicting the 1-, 3-, and 5-year cause-specific mortality in PGC. The nomograms showed relatively good performance and can be used in clinical practice to assist clinicians in individualized treatment decision-making.

Survival outcomes in patients with parotid gland carcinoma treated with postoperative therapies using risk stratification.

BACKGROUND: To evaluate the role of postoperative treatment in parotid gland carcinoma (PGC) based on risk stratification. MATERIAL AND METHODS: A total of 301 PGC patients were retrospectively analyzed using risk stratification. The Kaplan-Meier method and Cox analysis were performed to conduct survival analysis. RESULTS: In the high-risk group, those treated with postoperative radiotherapy (RT) had a better 5-year disease-free survival (DFS) than those treated with surgery alone. In the low-risk group, both surgery + RT and surgery + chemotherapy (CT) significantly improved DFS when compared with surgery alone. Cox analysis showed that patients who underwent surgery + RT or surgery + CT had a lower risk of disease progression than those who underwent surgery alone in the low-risk group. In the high-risk group, patients who underwent surgery + RT had a lower risk of disease progression. CONCLUSIONS: Postoperative RT showed considerable benefit in improving disease control in patients with PGC, even in those without high-risk factors.

Prognostic scoring models in parotid gland carcinoma.

BACKGROUND: The aim was to identify prognostic factors and test three prognostic scoring models that predicted the risk of recurrence in patients with parotid gland carcinoma. METHODS: All Danish patients with parotid gland carcinoma, treated with curative intent, from 1990 to 2015 (n = 726) were included. Potential prognostic factors were evaluated using Cox regression and competing risk analyses. The concordance of each prognostic model was estimated using Harrel's C index. RESULTS: The study population consisted of 344 men and 382 women, with a median age of 63 years. Age above 60 years, high grade histology, T3/T4 tumor, regional lymph node metastases, and involved surgical margins were all associated with a significant reduction in recurrence-free survival. The prognostic model that agreed best with actual outcomes had a C-index of 0.76. CONCLUSION: Prognostic scoring models may improve individualized follow-up strategies after curatively intended treatment for patients with parotid gland carcinoma.

Prognostic Value of the Lymphocyte-to-Monocyte Ratio in Patients with Parotid Gland Carcinoma.

OBJECTIVE: Previous studies have evaluated various markers as prognostic predictors in patients with many types of cancers. However, the influence of such factors on the outcomes of patients with parotid gland carcinoma (PGC) is unknown. This study investigated the roles of alternative markers in the prognoses of patients with PGC. METHODS: Overall, 101 patients who underwent curative treatment for PGC were retrospectively evaluated, and their 5-year overall and disease-free survival rates were calculated. The prognostic values of clinical and pathologic factors were determined. RESULTS: The 5-year overall and disease-free survival rates were 73.1% and 62.8%, respectively. Multivariate analysis revealed that a low lymphocyte-to-monocyte ratio (LMR), high T classification, high N classification, and perineural invasion were independent predictors of poor prognosis. CONCLUSIONS: Thus, we identified LMR as an independent prognostic factor for patients with PGC. Patients with low LMRs who are amenable to treatment may require adjuvant treatment to improve their prognoses. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E864-E869, 2021.

Mandibular growth in survivors of pediatric parotid gland carcinoma treated with interstitial brachytherapy.

BACKGROUND: The aim of the study was to present long-term results of mandibular growth in pediatric parotid gland carcinoma survivors treated with interstitial brachytherapy. PROCEDURE: Twenty-five survivors of pediatric parotid gland carcinoma treated with iodine-125 seed interstitial brachytherapy were included for quantitative analysis, including three dimensional (3D) cephalometry and measurement of mandibular volume. RESULTS: 3D cephalometry showed that the median fore-and-aft increments of the lengths of the condyle, the ramus, and the body of the mandible were 1.23, 0.19, and 1.66 mm for the affected side, respectively, and were 1.37, 1.95, and 3.42 mm for the unaffected side, respectively. The difference in increments of the ramus was statistically significant between the affected side and the unaffected side (P = 0.003; P < 0.05). Moreover, mandibular volume measurements showed that the median fore-and-aft increments of the volumes of the condyle, the ramus, and the body of the mandible were 290.62, 220.14, and 1706.40 mm3 for the affected side, respectively, and were 269.15, 370.40, and 1469.86 mm3 for the unaffected side, respectively. The difference in increments was statistically significant between the affected side and the unaffected side for the ramus (P = 0.005; P < 0.05) and the body (P = 0.043; P < .05). CONCLUSION: Mandibular growth was affected by interstitial brachytherapy, especially for the ramus, in pediatric parotid gland carcinoma survivors treated with interstitial brachytherapy. Nevertheless, the impact was mild in these survivors.

Iodine-125 brachytherapy alone for advanced primary parotid gland carcinoma.

This study aimed to evaluate the efficacy of iodine-125 (125I) brachytherapy alone for the treatment of advanced parotid gland carcinoma and to identify predictors of tumour control and patient survival. Primary parotid gland carcinoma patients (n=23) treated with 125I brachytherapy alone between 1 October 2005 and 31 July 2013 at Peking University Stomatology Hospital were enrolled in this retrospective study. All had clinical stage IV disease. The prescribed dose was 60-160Gy. The local control rate, survival rate, and predictors of the prognosis were evaluated. Adverse events related to treatment were also noted. The average follow-up time was 29 months (range 9-74 months). Among the 23 patients, six had local failure and 11 died during the follow-up period. The 1-, 3-, and 5-year overall survival rates were 87.0%, 55.4%, and 47.5%, respectively. The 1-, 3-, and 5-year progression-free survival rates were 73.9%, 47.0%, and 39.2%, respectively. The 1-, 3-, and 5-year local control rates were 82.1%, 73.9%, and 73.9%, respectively. Age and distant metastasis were independent predictors of survival, while the preoperative duration of the disease was an independent predictor of local control. The use of 125I seed brachytherapy alone for the treatment of primary parotid gland carcinoma can provide good short-term results without causing any severe side effects.

Survival in patients with parotid gland carcinoma - Results of a multi-center study.

BACKGROUND: Parotid gland carcinoma is a rare malignancy, comprising only 1-4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach. METHODS: The study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS: The median patient age was 63years old (range 9-93years), and the median observation period was 39months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N+, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N+ and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients. CONCLUSION: Nodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma.

Definitive carbon-ion radiotherapy for locally advanced parotid gland carcinomas.

BACKGROUND: The purpose of this study was to present our evaluation of the safety and efficacy of carbon-ion radiotherapy (C-ion RT) for locally advanced parotid gland carcinomas. METHODS: Clinicopathological features and outcomes were evaluated in 46 patients receiving C-ion RT for parotid gland carcinomas. RESULTS: Sixteen patients had adenoid cystic carcinoma; 8 had adenocarcinoma, 8 had mucoepidermoid carcinoma, and 14 had other carcinomas. T2, T3, T4a, and T4b diseases were diagnosed in 3, 18, 8, and 17 patients, respectively. C-ion RT was provided to 25 patients as the primary treatment, to 20 patients for local recurrences after surgery, and to 1 patient for residual tumor after surgery. During follow-up (median duration, 62 months), 5-year local control and overall survival (OS) rates were 74.5% and 70.1%, respectively. Of the 30 patients without facial nerve palsy before C-ion RT, 25 showed no radiation-induced facial nerve palsy. CONCLUSION: C-ion RT is effective and has acceptable toxicity levels for locally advanced parotid gland carcinomas. © 2016 Wiley Periodicals, Inc. Head Neck 39: 724-729, 2017.

Clinical analysis of 125Ⅰ brachytherapy alone for 24 recurrent parotid gland carcinoma / 中华放射医学与防护杂志

Objective To evaluate the efficacy of 125Ⅰ brachytherapy alone for the treatment of recurrent parotid gland carcinoma.Methods Recurrent parotid gland carcinoma patients (n =24) treated by 125Ⅰ brachytherapy alone between 2006 and 2013 at Peking University Hospital of Stomatology were enrolled in this retrospective study.All patients underwent surgery or radiotherapy.The local control rate,survival rate,and side effects were evaluated.Results The median follow-up time was 21 months (range,4-59 months).Among the 24 patients,6 had local failure and 10 died during the follow-up period.The 1-and 3-year overall survival rates,progression-free survival rates,local control rates were 74.8％ and 39.3％,74.8％ and 31.5％,82.0％ and 69.4％,respectively.No grade 3 or over radiation injury was found.Conclusions 125Ⅰ seed brachytherapy alone could provide an ahernative treatment method for inoperable recurrent parotid gland carcinoma patients.

Histological reclassification of parotid gland carcinomas: importance for clinicians.

Reassessment of histological specimens of salivary gland carcinomas is associated with a change of primary diagnosis in a significant number of patients. The authors evaluated the relation between reclassification/verification of histological diagnosis and the clinical course of parotid gland carcinomas. Histological and immunohistochemical examinations of 111 specimens of parotid gland carcinomas operated on during the years 1992-2010 were revised and in some cases supplemented with cytogenetic tests (FISH), to verify the diagnosis and potentially reclassify the tumours. Analysis of the clinical documentation and follow-up data of patients whose diagnosis was changed was then carried out. The prognostic factors taken into account in the evaluation of the clinical course included the T and N stage, the tumour grade and the extent of resection. The primary diagnosis was changed on review in 28 patients (25.2 %). In 16 patients, the change involved a different histological type of cancer. In six cases, what was thought to be a primary salivary gland cancer was reclassified as a secondary tumour. In four other cases, the change was made from a malignant to a benign tumour and in one case to a non-neoplastic lesion (necrotizing sialometaplasia). Additionally, in two patients with carcinoma ex pleomorphic adenoma, the malignant component was found to be of in situ type. A potentially atypical clinical course was observed in 4 out of 28 patients whose diagnosis was changed. In the case of 2 patients, the course of disease was more aggressive (dissemination, death) than predicted and less aggressive in rest of the patients. Histological reclassification/verification of parotid gland carcinomas can explain the cause of an atypical clinical course in some patients and sometimes enables doctors to implement a change in therapy.

Parotidectomy for Parotid Cancer.

Parotidectomy for parotid cancer includes management of primary salivary cancer, metastatic cancer to lymph nodes, and direct extension from surrounding structures or cutaneous malignancies. Preoperative evaluation should provide surgeons with enough information to plan a sound operation and adequately counsel patients. Facial nerve sacrifice is sometimes required; but in preoperative functioning nerves, function should be preserved. Although nerve involvement predicts poor outcome, survival of around 50% has been reported for primary parotid malignancy. Metastatic cutaneous squamous cell carcinoma is a high-grade aggressive histology whereby local control for palliation with extended parotidectomy can be achieved; however, overall survival remains poor.