Low-dose radiotherapy for multicystic benign lymphoepithelial lesions of the parotid gland in HIV-positive patients: long-term results.

Abstract

Multicystic benign lymphoepithelial lesions of the parotid gland (BLL) seen in patients with human immunodeficiency virus (HIV) can produce considerable cosmetic deformity as well as physical discomfort. We previously reported our preliminary results with low-dose radiotherapy in this disease, and all 8 patients were satisfied with the initial improvement in their appearance. We now report the long-term follow-up of those patients and additional patients. Twelve HIV-positive patients with BLL were treated with 8-10 Gy of external radiation using 2-Gy daily fractions. Objective responses and subjective duration of patient-defined cosmetic control were recorded. All 12 patients (100%) had at least a 50% decrease in the size of their parotid masses. Five of 12 (42%) had a complete response and 7 (58%) had a partial response. Persisting complete response was achieved in only 1 patient, however, with relapse in the other 11 patients. Cosmetic palliation, as judged by the patients, was achieved for a median of 9.5 months. Eight patients were subsequently retreated with doses of 6-16 Gy (median and mode: 10 Gy). None (0%) of the 8 patients retreated achieved local control. Very low-dose radiation (8-10 Gy) provides reliable but temporary cosmetic palliation for BLL. Retreatment was unsatisfactory, and we are now investigating higher initial doses of radiation to prolong palliation and eliminate recurrences.