Management algorithm for HIV-associated parotid lymphoepithelial cysts.

Abstract

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18Gy), which received a median dose of 10Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93%, respectively. In group B (≥22.5Gy), which received a median dose of 24Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12%. Logistic regression revealed that higher dose (≥22.5Gy) predicted for cosmetic control (p=0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p=0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24Gy delivered in 12-16 fractions of 1.5-2Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.