DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20185310

Management of the neck in malignant parotid neoplasm

Ahmed Abdelwanis, Sowrav Barman

Abstract


Parotid gland cancer (PGC) are rare and accounts for 3% of all head and neck malignancies.The classification of parotid tumour is complex and comprises both benign and malignant neoplasms of epithelial and non-epithelial origin.There is marked variation in the histological features of these tumours,therefore treatment options of parotid cancer is widely varied.Lymph node metastasis to the neck is one of the most important factors in therapy and prognosis for patients with parotid malignancy. This article reviews the literature regarding neck management of parotid cancer in cases of both clinically positive (cN+) and clinically negative (cN-) neck nodes. The literature search was performed using Google search engine, PUB Med to identify relevant articles on recommendations for neck management in patients with parotid cancer in cases of both clinically positive (cN+) and negative (cN-) neck nodes. Due to the rarity of parotid cancer and the wide histopathological varieties, the literature was hard to interpret. There is a consensus about managing clinically positive neck with therapeutic neck dissection. Most studies agree on elective neck dissection in certain indications which are high T stage, high grade histology, facial paralysis, age, extraglandular extension, peri-lymphatic invasion. Level II to IV appears to be at higher risk and can be done through the same parotidectomy incision. The role of irradiation in cN- necks is not clear but some studies recommend its usage for curative intent and argue that it adds less morbidity than the elective neck dissection. Although the management of the neck in cN+ patients is widely agreed, controversy still exists about the need for elective neck dissection in cN- patients and the levels which should be dissected.


Keywords


Neck nodes, Neck dissection, Parotid cancer

Full Text:

PDF

References


Barnes L, Eveson JW, Reichart P. Tumours of the salivary gland pathology and genetics. Head and neck tumours. World Health Organization Classification of tumours. IARC Press, Lyon; 2005: 209–281.

Jones AV, Craig GT, Speight PM.The range and demographics of salivary gland tumours diagnosed in a UK population. Oral Oncol. 2008;44:407.

Santos IR, Kowalski LP, Araujo VC. Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas. Arch Otolaryngol Head Neck Surg. 2001;127:56-60.

Brunicardi FC, Andersen DK, Billar TR. Schwartz's Principles of Surgery.9th edition. McGraw Hill: New York; 2010: 916-988.

Barry F, Ching W, Denise C. The MD Anderson Surgical Oncology Handbook. 5th edition.A Lippincott Williams & Wilkins: Philadelphia; 2012:196-219.

Ferlito A, Shaha AR, Rinaldo A. Management of clinically negative cervical lymph nodes in patients with malignant neoplasms of the parotid gland.ORL J Otorhinolaryngol Relat Spec. 2001;63(3):123–6.

Ali S, Palmer FL, DiLorenzo M. Treatment of the Neck in Carcinoma of the Parotid Gland. Ann Surg Oncol. 2014;21:3042-8.

Spiro RH, Huvos AG, Strong EW. A clinicopathologic study of 288 primary cases. Cancer of The Parotid Gland. Am J Surg. 1975;130:452–9.

Zbaren P, Schupbach J, Nuyens M. Elective neck dissection versus observation in primary parotid carcinoma. Otolaryngol Head Neck Surg. 2005;132:387–91.

Valstar MH, Van den Brekel MW, Smeele LE. Interpretation of treatment outcome in the clinically node-negative neck in primary parotid carcinoma: A systematic review of the literature. Head Neck. 2009;32:1402.

Eneroth CM. Facial nerve paralysis: a criterion of malignancy in parotid tumours. Arch Otolaryngol. 1972;95:300-4.

Conley J, Hanamaker RC. Prognosis of malignant tumours of the parotid gland with facial paralysis. Arch Otolaryngol. 1975;101:39-41.

Armstrong JG, Harrison LB, Thaler HT, Friedlander-Klar H, Fass DE, Zelefsky MJ. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer 1992;69:615–9.

Rice D, Hemenway W, Cannalis R. Malignant neoplasms of the salivary glands. In: English GM, ed. Otolaryngology. 1984: 1–15.

McGuirt WF. Management of occult metastatic disease from salivary gland neoplasms. Arch Otolaryngol Head Neck Surg. 1989;115:322–5.

Krause CJ. The management of parotid neoplasms. Head Neck Surg. 1981;3:340–3.

Johns ME. Parotid cancer: a rational basis for treatment. Head Neck Surg. 1980;3:132–41.

Frankenthaler RA, Byers RM, Luna MA. Predicting occult lymph node metastasis in parotid cancer. Arch Otolaryngol Head Neck Surg. 1993;119:517-20.

Ball A, Fish S, Meirion T. Malignant epithelial parotid tumours: a rational treatment policy. Br J Surg. 1995;82:621-3.

Kelley DJ, Spiro RH. Management of the neck in parotid carcinoma. Am J Surg. 1996;172:695–7.

Medina JE. Neck dissection in the treatment of cancer of major salivary glands. Otolaryngol Clin N Am. 1998;31:815–22.

Kawata R, Koutetsu L, Yoshimura K. Indication for elective neck dissection for N0 carcinoma of the parotid gland: a single institution’s 20-year experience. Acta Otolaryngol. 2010;130:286–92.

Zbären P, Schär C, Hotz MA. Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope. 2001;111:1989-92.

Al-Khafaji BM, Nestok BR, Katz RL. Fine-needle aspiration of 154 parotid masses with histologic correlation. Cancer 1998;84:153-9.

Santos RDBI, Kowalski LP, Araujo VCD. Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas. Arch Otolaryngol Head Neck Surg. 2001;127:56–60.

Stennert E, Kisner D, Jungehuelsing M. High incidence of lymph node metastasis in major salivary gland cancer. Arch Otolaryngol Head Neck Surg. 2003;129:720.

Spiro RH, Huvos AG, Berk R. Mucoepidermoid carcinoma of salivary gland origin.A clinicopathologic study of 367 cases. Am J Surg. 1978;136:461.

Chen AM, Garcia J, Lee NY. Patterns of nodal relapse after surgery and postoperative radiation therapy for carcinomas of the major and minor salivary glands: what is the role of elective neck irradiation. Int J Radiat Oncol Biol Phys. 2007;67:988–94.

Schiff BA, Roberts DB, El-Naggar A. Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue. Arch Otolaryngol Head Neck Surg. 2005;131:874–8.

Herman MP, Werning JW, Morris CG, Kirwan JM, Amdur RJ, Mendenhall WM. Elective neck management for high-grade salivary gland carcinoma. Am J Otolaryngol. 2013;34(3):205-8.