Abstract
Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0.3% of all malignancies. The majority (75%) of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma (MEC) makes up 40–50% of malignant parotid gland tumors. No randomized controlled trials exist regarding the role of adjuvant radiation for patients who undergo surgical resection of low-grade MECs. Herein, we report two cases of successful postoperative radiation therapy in low-grade, pT2N0 MEC of the parotid gland. The role of adjuvant radiation therapy for patients with MEC of the parotid gland is based on data from institution reviews and lacks data from randomized controlled trials. Per our review of the literature, the pathological findings of positive surgical margins and/or perineural invasion in two patients with low-grade MEC of the parotid gland warranted adjuvant radiation for improved local control after partial parotidectomy. Both patients tolerated postoperative radiation therapy with only mild side effects and, at last follow-up, five years after completion of therapy, had no clinical or radiographic evidence of either local recurrence or distant metastasis.
Highlights
The majority (75%) of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma (MEC) makes up 40– 50% of malignant parotid gland tumors [1,2,3]
Patients with salivary gland tumors commonly present with a mass and/or localized pain. Management of these cancers typically involves surgical resection with postoperative radiation therapy considered in cases where there is concern for local failure based on pathological assessment
For intermediate or high-grade MEC, adjuvant radiation therapy appears to aid in local control in cases of advanced staging, close or positive surgical margins, high-grade histology, perineural invasion, or lymphovascular invasion
Summary
Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0.3% of all malignancies [1]. MECs were first described by Stewart et al [4] in 1945 and are made up of three cell types in differing proportions: mucous-producing cells, epidermoid cells with squamous differentiation, and undifferentiated small cells These tumors are typically classified into three histologic grades (low, intermediate, or high) according to the Armed Forces Institute of Pathology (AFIP) grading scheme, based on characteristics such as presence of intracystic components, neural invasion, necrosis, anaplasia, and level of mitotic activity. Patients with salivary gland tumors commonly present with a mass and/or localized pain Management of these cancers typically involves surgical resection with postoperative radiation therapy considered in cases where there is concern for local failure based on pathological assessment. His physical exam and MR imaging 5 years after completion of therapy demonstrated no evidence of recurrent disease
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