Clinical investigation: Head and neck
Malignant parotid tumors: Presentation, clinical/pathologic prognostic factors, and treatment outcomes

Presented at the Triological Society Southern and Middle Section Meeting, Marco Island, FL, January 8–11, 2004.
https://doi.org/10.1016/j.ijrobp.2004.04.052Get rights and content

Abstract

Purpose

To determine the important clinical/pathologic prognostic factors and optimal treatment of malignant parotid tumors.

Methods and materials

This study was a retrospective chart review of 163 patients treated for malignant parotid tumors at two institutions. Of the 163 patients, 91 were treated with surgical resection and radiotherapy (RT), 56 were treated with surgery alone, and 13 were treated with RT alone. The median follow-up was 5.1 years (range, 0–37 years).

Results

Locoregional recurrence occurred in 37% of surgery-only, 11% of surgery plus RT, and 15% of RT-only patients (p = 0.001, Pearson's chi-square test). Cox proportional hazard multivariate analysis revealed that increasing age and higher stage were each statistically significantly (p < 0.05) associated with a poorer overall 5-year survival and cause-specific survival. Only increasing age and the absence of adjuvant RT were shown in Cox proportional hazard multivariate analysis to impact negatively on local failure–free survival.

Conclusion

In Cox proportional hazards multivariate analysis, only increasing age and stage were statistically significant prognostic factors for survival. The addition of RT to surgery did not improve overall survival but did reduce locoregional recurrence and improve local failure–free survival.

Introduction

Malignant parotid tumors are an uncommon head-and-neck malignancy. The incidence of malignant salivary gland tumors in the United States is 1.2/100,000 population (1), with parotid malignancies accounting for 50–70% of these tumors 2, 3. Thus, prospective management trials for this group have not been performed. Therefore, retrospective review of patient data is required to determine the optimal treatment for these patients. The benefits from radiotherapy (RT), the most important prognostic factors, and the optimal surgery for these patients continues to be debated.

Section snippets

Methods and materials

We reviewed the charts of all patients (n = 181) diagnosed with epithelial malignant parotid tumors between 1960 and 2000 at Kansas University Medical Center (KUMC) and between 1970 and 2000 at the State University of New York Upstate Medical University (SUNY Upstate). Eighteen patients were excluded from our retrospective study. Of these, 14 were missing vital information, 3 had not received treatment, and 1 was missing RT details. Thus, 163 patients were available for analysis. To ensure

Results

As shown in Table 1, the mean patient age at diagnosis was 59.4 years (standard deviation 18); 52% of the patient population was male. The patients from KUMC comprised 56% (n = 92) of the study population, and 44% (n = 71) were diagnosed and treated at SUNY Upstate.

Nearly all patients presented with a mass (Table 1), as well as several other clinical signs and symptoms, including pain and facial weakness. Of the 163 patients, 68 (42%) had Stage I at presentation, 20 (12%) had Stage II, 3 (2%)

Discussion

Several retrospective series have detailed their treatment results and prognostic factors in patients with malignant parotid tumors, but no randomized or prospective trials have been performed. Limitations in the literature included insufficient numbers in all but a few studies using multivariate analysis to identify prognostic factors. Many studies had no staging system listed or reported on a large percentage of patients without staging and did not state whether the tumor was clinically or

Conclusion

Malignant parotid tumors have been managed during the past few decades with differing surgical and RT protocols and techniques. A number of important patient, pathologic, and treatment characteristics influence survival and local failure. Higher stage using the AJCC 5th edition criteria and increasing age are predictors of poorer local failure-free survival, cause-specific survival, and overall survival. Adjuvant RT is of value in improving locoregional control in some patients and improved

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