Background/Aims: The importance of adjuvant radiotherapy in patients with close margin resections for mucoepidermoid carcinoma of the parotid gland remains unclear. Methods: Patients who underwent parotidectomy for mucoepidermoid carcinoma with or without adjuvant radiotherapy at a single academic tertiary care center from 2000 to 2014 were identified. Included patients had negative but close (≤2 mm) surgical margins without other high-risk histopathological factors including advanced T-stage, positive nodal disease, lymphovascular or perineural invasion, or high-grade histology. Results: Nineteen patients were identified, of whom 15 (79%) were observed postoperatively, while 4 (21%) underwent adjuvant radiotherapy. There were no significant differences in extent of parotidectomy, elective neck dissection, T staging, or tumor size between patients who were observed and those undergoing adjuvant radiation. There were no locoregional or distant recurrences in any patients at a mean follow up 74.3 months. Patients undergoing adjuvant radiation, however, had significantly more intermediate-grade as compared to low-grade histology (75% vs. 13%, difference 62%, 95% CI 4% to 100%). Conclusions: Patients with negative but close (≤2 mm) surgical margins without other high-risk histopathological factors have excellent long-term locoregional control with surgery alone. The effects of adjuvant radiotherapy for those who have intermediate-grade disease remain uncertain.

1.
Byrd
SA
,
Spector
ME
,
Carey
TE
,
Bradford
CR
,
McHugh
JB
.
Predictors of recurrence and survival for head and neck mucoepidermoid carcinoma
.
Otolaryngol Head Neck Surg
.
2013
Sep
;
149
(
3
):
402
8
.
[PubMed]
0194-5998
2.
Aro
K
,
Leivo
I
,
Mäkitie
AA
.
Management and outcome of patients with mucoepidermoid carcinoma of major salivary gland origin: a single institution’s 30-year experience
.
Laryngoscope
.
2008
Feb
;
118
(
2
):
258
62
.
[PubMed]
0023-852X
3.
Katabi
N
,
Ghossein
R
,
Ali
S
,
Dogan
S
,
Klimstra
D
,
Ganly
I
.
Prognostic features in mucoepidermoid carcinoma of major salivary glands with emphasis on tumour histologic grading
.
Histopathology
.
2014
Dec
;
65
(
6
):
793
804
.
[PubMed]
0309-0167
4.
Coca-Pelaz
A
,
Rodrigo
JP
,
Triantafyllou
A
,
Hunt
JL
,
Rinaldo
A
,
Strojan
P
, et al.
Salivary mucoepidermoid carcinoma revisited
.
Eur Arch Otorhinolaryngol
.
2015
Apr
;
272
(
4
):
799
819
.
[PubMed]
0937-4477
5.
Chen
AM
,
Lau
VH
,
Farwell
DG
,
Luu
Q
,
Donald
PJ
.
Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: clinicopathologic correlates of outcome
.
Laryngoscope
.
2013
Dec
;
123
(
12
):
3049
55
.
[PubMed]
0023-852X
6.
Armstrong
JG
,
Harrison
LB
,
Spiro
RH
,
Fass
DE
,
Strong
EW
,
Fuks
ZY
.
Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy
.
Arch Otolaryngol Head Neck Surg
.
1990
Mar
;
116
(
3
):
290
3
.
[PubMed]
0886-4470
7.
Cho
JK
,
Lim
BW
,
Kim
EH
,
Ko
YH
,
Oh
D
,
Noh
JM
, et al.
Low-Grade Salivary Gland Cancers: Treatment Outcomes, Extent of Surgery and Indications for Postoperative Adjuvant Radiation Therapy
.
Ann Surg Oncol
.
2016
Dec
;
23
(
13
):
4368
75
.
[PubMed]
1068-9265
8.
Garden
AS
,
el-Naggar
AK
,
Morrison
WH
,
Callender
DL
,
Ang
KK
,
Peters
LJ
.
Postoperative radiotherapy for malignant tumors of the parotid gland
.
Int J Radiat Oncol Biol Phys
.
1997
Jan
;
37
(
1
):
79
85
.
[PubMed]
0360-3016
9.
Olsen
MP
,
Mitchell
AO
,
Miles
EF
.
Postoperative radiation therapy for parotid mucoepidermoid carcinoma
.
Case Rep Oncol Med
.
2014
;
2014
:
345128
.
[PubMed]
2090-6706
10.
Ghosh-Laskar
S
,
Murthy
V
,
Wadasadawala
T
,
Agarwal
J
,
Budrukkar
A
,
Patil
N
, et al.
Mucoepidermoid carcinoma of the parotid gland: factors affecting outcome
.
Head Neck
.
2011
Apr
;
33
(
4
):
497
503
.
[PubMed]
1043-3074
11.
Richter
SM
,
Friedmann
P
,
Mourad
WF
,
Hu
KS
,
Persky
MS
,
Harrison
LB
.
Postoperative radiation therapy for small, low-/intermediate-grade parotid tumors with close and/or positive surgical margins
.
Head Neck
.
2012
Jul
;
34
(
7
):
953
5
.
[PubMed]
1043-3074
12.
Stodulski
D
,
Mikaszewski
B
,
Majewska
H
,
Wiśniewski
P
,
Stankiewicz
C
.
Close surgical margin after conservative parotidectomy in early stage low-/intermediate-grade parotid carcinoma: outcome of watch and wait policy
.
Oral Oncol
.
2017
May
;
68
:
1
4
.
[PubMed]
1368-8375
13.
Zenga
J
,
Parikh
A
,
Emerick
KS
,
Lin
DT
,
Faquin
WC
,
Deschler
DG
.
Acinic Cell Carcinoma of the Parotid: Close Margins and Adjuvant Radiation
.
JAMA Otolaryngol Head Neck Surg
. Forthcoming
2018
. 2168-6181
14.
Chen
AM
,
Granchi
PJ
,
Garcia
J
,
Bucci
MK
,
Fu
KK
,
Eisele
DW
.
Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: implications for adjuvant therapy
.
Int J Radiat Oncol Biol Phys
.
2007
Mar
;
67
(
4
):
982
7
.
[PubMed]
0360-3016
15.
Sharon
JD
,
Khwaja
SS
,
Drescher
A
,
Gay
H
,
Chole
RA
.
Osteoradionecrosis of the temporal bone: a case series
.
Otol Neurotol
.
2014
Aug
;
35
(
7
):
1207
17
.
[PubMed]
1531-7129
16.
Hey
J
,
Setz
J
,
Gerlach
R
,
Janich
M
,
Hildebrandt
G
,
Vordermark
D
, et al.
Parotid gland-recovery after radiotherapy in the head and neck region—36 months follow-up of a prospective clinical study
.
Radiat Oncol
.
2011
Sep
;
6
(
1
):
125
.
[PubMed]
1748-717X
17.
Deasy
JO
,
Moiseenko
V
,
Marks
L
,
Chao
KS
,
Nam
J
,
Eisbruch
A
.
Radiotherapy dose-volume effects on salivary gland function
.
Int J Radiat Oncol Biol Phys
.
2010
Mar
;
76
(
3
Suppl
):
S58
63
.
[PubMed]
0360-3016
18.
Yaparpalvi
R
,
Fontenla
DP
,
Tyerech
SK
,
Boselli
LR
,
Beitler
JJ
.
Parotid gland tumors: a comparison of postoperative radiotherapy techniques using three dimensional (3D) dose distributions and dose-volume histograms (DVHS)
.
Int J Radiat Oncol Biol Phys
.
1998
Jan
;
40
(
1
):
43
9
.
[PubMed]
0360-3016
19.
Brusić
SK
,
Pusić
M
,
Cvjetković
N
,
Karnjus
R
,
Candrlić
B
,
Kukuljan
M
, et al.
Osteosarcoma of the mastoid process following radiation therapy of mucoepidermoid carcinoma of the parotid gland—a case report
.
Coll Antropol
.
2012
Nov
;
36
Suppl 2
:
223
5
.
[PubMed]
0350-6134
20.
Coghlan
KM
,
Magennis
P
.
Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature
.
Int J Oral Maxillofac Surg
.
1999
Feb
;
28
(
1
):
50
2
.
[PubMed]
0901-5027
21.
Johnson
J
,
van As-Brooks
CJ
,
Fagerberg-Mohlin
B
,
Finizia
C
.
Trismus in head and neck cancer patients in Sweden: incidence and risk factors
.
Med Sci Monit
.
2010
Jun
;
16
(
6
):
CR278
82
.
[PubMed]
1643-3750
22.
Spellman
J
,
Calzada
G
.
Mucoepidermoid Carcinoma: A 23-Year Experience with Emphasis on Low-Grade Tumors with Close/Positive Margins
.
Otolaryngol Head Neck Surg
.
2018
May
;
158
(
5
):
889
95
.
[PubMed]
0194-5998
23.
Nance
MA
,
Seethala
RR
,
Wang
Y
,
Chiosea
SI
,
Myers
EN
,
Johnson
JT
, et al.
Treatment and survival outcomes based on histologic grading in patients with head and neck mucoepidermoid carcinoma
.
Cancer
.
2008
Oct
;
113
(
8
):
2082
9
.
[PubMed]
0008-543X
24.
Chen
MM
,
Roman
SA
,
Sosa
JA
,
Judson
BL
.
Histologic grade as prognostic indicator for mucoepidermoid carcinoma: a population-level analysis of 2400 patients
.
Head Neck
.
2014
Feb
;
36
(
2
):
158
63
.
[PubMed]
1043-3074
25.
Liu
S
,
Ow
A
,
Ruan
M
,
Yang
W
,
Zhang
C
,
Wang
L
, et al.
Prognostic factors in primary salivary gland mucoepidermoid carcinoma: an analysis of 376 cases in an Eastern Chinese population
.
Int J Oral Maxillofac Surg
.
2014
Jun
;
43
(
6
):
667
73
.
[PubMed]
0901-5027
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.