Metastatic XXXX to the parotid: the role of surgery and adjuvant radiotherapy to achieve best outcome.

@entity1 @entity957
BACKGROUND: Australia has the highest incidence of @entity957 in the world. The majority of lesions occur in the head and neck with metastases to the parotid gland lymph nodes reflecting an uncommon, but aggressive, manifestation. Parotidectomy +/- neck dissection followed by adjuvant radiotherapy should be considered as best practice. METHODS: Between 1983 and 2000, seventy-four @entity1 were treated for metastatic @entity957 to the parotid with surgery and adjuvant radiotherapy at Westmead Hospital, Sydney. Relevant data were extracted from @entity1 files and a prospectively maintained database. Patterns of relapse and outcome were analysed. RESULTS: Median age at diagnosis was 65 years (34-93 years) in 63 @entity1 and 11 @entity1 . Median follow-up duration was 41 months (12-188 months). All @entity1 underwent parotidectomy with 52 undergoing a simultaneous neck dissection. Twelve @entity1 required sacrifice of the facial nerve (4) or one or more branches (8). All received adjuvant radiotherapy to the parotid region with 56 also receiving radiotherapy to the ipsilateral neck. Despite treatment, 24% developed locoregional recurrence, with a median time to relapse of 7.5 months. The most common site for recurrence was the treated parotid region and upper neck. Most relapsed @entity1 died. No variable independently predicted for locoregional recurrence on multivariate analysis. The 5-year absolute and cause-specific survival rates were 58% and 72%, respectively. CONCLUSION: Parotid gland lymph node metastases from @entity957 are associated with a high rate of recurrence and cause-specific mortality despite current best practice (surgery and high dose adjuvant radiotherapy). The role of more aggressive surgery, altered fractionation or chemotherapy to enhance locoregional control remains unclear.
