Parotid Gland Cancer Research Articles

Interpretation of Timetrends (1996-2017) of the Incidence of Selected Cancers in England in Relation to Mobile Phone Use as a Possible Risk Factor.

Radiofrequency (RF) radiation from mobile phones has been classified as possibly carcinogenic to humans (2b) by IARC. However, to date, the discussion on whether mobile phone use is a cancer risk factor has not been solved. In this context of continuing uncertainty, it is important to continue to monitor cancer incidence trends. Annual incidence rates and directly age-standardized rates of selected cancers by sex and 5-year age groups for 1996 to 2017 for England were obtained from the UK Office for National Statistics. Interpretation in light of mobile phone use as a contributing risk factor was conducted for cancers of the brain, parotid gland, thyroid, and colorectal cancer, which have all been hypothesized to be associated with RF exposure. Brain and parotid gland cancers were updated by an additional 10 years following a previous publication, and continue to provide little evidence of an association with mobile phone use. Although mobile phone use as a potential risk factor contributing to increased incidence of colorectal or thyroid cancer could not be excluded based on these ecological data, it is implausible that it is an important risk factor for either. In the absence of clarity from epidemiological studies, it remains important to continue to monitor trends. However, for the time being, and in agreement with data from other countries, there is little evidence of an association between mobile phone use and brain or parotid gland cancer, while the hypotheses of associations with thyroid or colorectal cancer are similarly weak. © 2021 Bioelectromagnetics Society.

Development and validation of nomograms for predicting survival and recurrence in patients with parotid gland cancer.

To develop nomograms for predicting recurrence risk and long-term survival in patients with parotid gland cancer (PGC). A total of 301 consecutive patients with PGC who underwent surgery were enrolled and randomly divided into a training cohort (n=210) and a validation cohort (n=91). Predictive nomograms were constructed based on the independent indicators of overall survival (OS) and disease-free survival (DFS) as determined by multivariate Cox regression analysis. The discrimination and calibration of nomograms were evaluated using C-indices and calibration curves. Six independent predictors of OS were identified. Incorporating these factors, the nomogram showed good concordance statistics of 0.84 and 0.78 in predicting the 5-year OS in the training and validation cohorts. Five independent predictors of DFS were identified and integrated into the nomogram. The concordance statistics were 0.84 and 0.74 in predicting the 5-year DFS in the training and validation cohorts. The predictive performance of the nomograms outperformed the TNM model. Additionally, the patients were divided into two groups according to the nomogram score, and significant differences in OS and DFS were observed between the high risk and low risk groups. Finally, the role of postoperative treatments was evaluated based on the risk stratification; patients at high risk of disease recurrence showed an improvement in DFS after receiving postoperative treatments. The nomogram showed good performance in predicting both OS and DFS in patients with PGC. It might be useful for selecting patients for postoperative treatments.

Mobile phone use and trends in the incidence of cancers of the parotid and other salivary glands

BackgroundThere has been a significant increase in the use of mobile phones over the last three decades and a possible association with head cancers has been suggested, including cancers of the parotic and other salivary glands. We examined the incidence time trends of parotid and other salivary gland cancers in Australia to ascertain the influence of increased mobile phone use. MethodsAnalyses of incidence time trends were carried out using Poisson regression to estimate the annual percentage change (APC) in the incidence of salivary gland cancers of all available national registration data from 1982 to 2016, as well as specific time periods (1982−1993, 1994−2005, 2006−2016) representing changes in the prevalence of mobile phone use. ResultsThe incidence of parotid gland cancer was stable for the periods 1982−1993 and 1994−2005. During 2006−2016 there was a large decrease in parotid gland cancer for males (APC: -3.71, 95 %CI: -6.66 to -0.67) and a large increase in females (4.80, 1.77–7.91) for adults aged 20−59 years. The incidence for other salivary gland cancers was stable during all the periods. ConclusionsThe results do not indicate that mobile phone use increased the incidence of parotid or other salivary gland cancers. An increase in parotid gland cancer in females since 2006 may be attributed to other possible risk factors specific to this gender.

Intracranial Remote Metastasis from Adenoid Cystic Cancer of Parotid Gland: Case Report and Review of Literature.

Adenoid cystic carcinoma is rare, locally aggressive salivary gland tumor. It has indolent course, multiple local recurrences and delayed distant metastasis in lung, bone, liver and soft tissues which are detected up to a maximum of 5.5years after local-regional resection of the primary tumor. Intracranial remote metastasis of ACCs is extremely rare, and very few cases have been reported in the literature. Here we report a rare case of intracranial remote metastasis of ACC of the parotid gland developed after 15years of primary curative surgery, emphasizing long term follow up on these cases.

Pericardial metastasis of parotid mucoepidermoid carcinoma diagnosed by pericardial biopsy

A 30-year-old man presented with swelling in the lower left ear. Close examination led to a diagnosis of parotid gland cancer, T4N0M0 Stage IVA, so total resection of the left parotid gland and left neck dissection were performed. Pathological examination led to a diagnosis of high-grade malignant-type mucoepidermoid, and chemoradiotherapy was performed as postoperative treatment. Fourteen days after completion of chemoradiotherapy, the patient was admitted to the hospital with headache and lack of appetite. Echocardiography showed a pericardial effusion and complete collapse of the right ventricle; cardiac tamponade was diagnosed, and pericardiocentesis was performed. The pericardial effusion was bloody, and a metastatic lesion was suspected, but cytological examination showed class IIIa. On day 33 of the illness, respiratory distress and hypotension were observed. A clot was seen covering the lower wall of the heart, and dilatation of the lower wall was significantly impaired. Pericardiotomy was performed on day 36. Pathological examination diagnosed cardiac metastasis of mucoepidermoid carcinoma of the parotid gland. Although only 4 cases of parotid cancer have been reported as primary lesions of metastatic heart tumors, this case represents the world's first description of isolated parenchymal metastasis of mucoepidermoid carcinoma of the parotid gland diagnosed by pericardial biopsy.

Clinical outcomes of bulky parotid gland cancers: need for self-examination and screening program for early diagnosis of parotid tumors

BackgroundEarly detection and diagnosis of parotid gland cancer (PGC) are essential to improve clinical outcomes, because Tumor-Node-Metastasis stage at diagnosis is a very strong indicator of prognosis in PGC. Nevertheless, some patients still present with large parotid mass, maybe due to the unawareness or ignorance of their disease. In this study, we aimed to present the clinical outcomes of bulky PGC (defined by a 4 cm cutoff point for T3–4 versus T1–2 tumors), to emphasize the necessity of a self-examination tool for parotid gland tumor.MethodsWe retrospectively reviewed 60 consecutive cases with bulky (equal to and greater than 4 cm in the longest diameter, determined radiologically) malignant tumors arising from the parotid gland from 1995 to 2016. The clinical and pathological factors were analyzed to identify risk factors for poor outcomes using Cox proportional hazard models. In addition, we designed a self-examination tool for parotid gland tumors, similar to breast self-examination for breast cancer detection.ResultsPatients with bulky parotid cancer showed 48.9% 5-year and 24.5% 10-year overall survival rates and a 47.9% risk of high-grade malignancy. The common pathological diagnoses were carcinoma ex pleomorphic adenoma (18.3%), adenocarcinoma (16.7%), mucoepidermoid carcinoma (16.7%), salivary duct carcinoma (16.7%), and adenoid cystic carcinoma (11.7%). Survival analyses revealed that tumor size (hazard ratio, HR = 1.262 upon increase of 1 cm, 95% confidence interval, 95%CI 1.059–1.502), lymph node metastasis (HR = 2.999, 95%CI 1.048–8.583), and high tumor grade (HR = 4.148, 95%CI 1.215–14.154) were independent prognostic factors in multivariable analysis. Functional preservation of the facial nerve was possible only in less than half of patients.ConclusionIn bulky PGC, lymph node metastasis at diagnosis and high tumor grade indicated poor survival outcomes, and functional outcomes of the facial nerve were suboptimal. Thus, a public effort seems to be necessary to decrease these patients with bulky PGC, and to increase patients’ self-awareness of their disease. As a way of early detection, we proposed a parotid self-examination tool to detect parotid gland tumors at an early stage, which is similar to breast self-examination.

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

Pre-treatment MRI predictor of high-grade malignant parotid gland cancer.

We aimed to evaluate pre-treatment MRI predictors of high-grade malignant parotid gland cancer by comparing MRI findings and texture parameters between high-grade and intermediate/low-grade parotid gland cancers. Patients underwent a pre-treatment MRI and had a parotid gland cancer resection with pathological evaluation. Evaluation objectives included attributive factors such as age and gender, several MRI findings of T1- and T2-weighted images, post-contrast fat suppression T1-weighted images, ADC value and 40 texture parameters calculated from T2-weighted axial images. Such objects were compared between high-grade and intermediate/low-grade lesions. Of the parotid gland cancers surveyed, 39 were included for analysis. Of these, 18 were high-grade lesions, 2 were intermediate-grade lesions, and 19 were low-grade lesions. The high-grade group was significantly older than the low- and intermediate-grade groups (p = 0.01). There were more males in the high-grade group than in the low- and intermediate-grade groups (p = 0.01). There were also significantly more MRI findings of neck lymph node metastases in the high-grade group than in the low- and intermediate-grade groups (p < 0.001). Other MRI findings and texture parameters did not show significant differences between the two groups (p = 0.07-1.00). Morphological assessment on MRI and texture parameters alone is not sufficient to estimate the grade of parotid cancer. MRI findings of neck lymph node metastases, as well as patient characteristics such as age (older patients) and gender (male) can be suggestive of high-grade parotid gland cancer in pre-treatment evaluation.

A Parsimonious Prognostic Model and Heat Map for Predicting Survival Following Adjuvant Radiotherapy in Parotid Gland Carcinoma With Lymph Node Metastasis.

Objectives:To construct a simplified prognostic risk model to predict overall survival after adjuvant radiotherapy for parotid gland carcinoma patients with stage T1-4aN1-3M0.Materials and Methods:We evaluated 879 patients who were pathological diagnosed as stage T1-4aN1-3M0 parotid gland cancer. Those eligible patients treated with parotidectomy and neck lymph node dissection between 2004 and 2015 in the Surveillance Epidemiology and End Results database. All cases received adjuvant radiotherapy. Independent prognostic factors included in the original model were identified by Cox regression analysis. The primary endpoint was overall survival. The model’s prediction power was evaluated by the concordance index. The entire cohort was categorized into new low- and high-risk groups using X-tile software according to the results of prognostic model. Kaplan-Meier method was used to depict the survival curves. And the statistical significance was determined by log-rank test. Besides, a heat map was visually described the association between the survival time and 2 most significant prognostic factors.Results:In the univariable and multivariate analyses, 4 independent factors for overall survival were age, tumor size, pTNM stage, and the number of positive lymph nodes, which were all selected in the parsimonious prognostic model. The concordance indices of the prognostic model and pTNM stage were 0.652 and 0.565, respectively. Patients in the low-risk group had better overall survival over patients in the high-risk group [unadjusted hazard ratio = 2.578, 95% confidence interval 2.095-3.172, P < 0.001]. The results of the heat map revealed that patients with smaller tumor size and fewer positive lymph nodes had much longer survival time.Conclusions:This parsimonious prognostic model could estimate the long-term survival after adjuvant radiotherapy for parotid gland carcinoma with stage T1-4aN1-3N0M0. The tools may be valuable to guide multidisciplinary team in making treatment decisions.

Investigation of parotid gland cancer surgery that preserved the facial nerve

Investigation of parotid gland cancer surgery that preserved the facial nerve

Preoperative and Non-Invasive Approach for Radiomic Biomarker-Based Prediction of Malignancy Grades in Patients with Parotid Gland Cancer in Magnetic Resonance Images

Preoperative and Non-Invasive Approach for Radiomic Biomarker-Based Prediction of Malignancy Grades in Patients with Parotid Gland Cancer in Magnetic Resonance Images

Prognostic role of intraparotid lymph node metastasis in primary parotid cancer: Systematic review.

The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear. Nineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review. The pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95-30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5-year recurrence-free survival rate based on Kaplan-Meier analysis varied from 83% to 88% in P- patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P- was 2.67 ± 0.58. P+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.

"Point line anterograde dissection" for the safe preparation of supraclavicular flap

Objective: To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ". Methods: A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded. Results: The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Conclusion: PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

Fluorescence navigation with indocyanine green for identification of intersegmental planes using a photodynamic eye camera.

BackgroundPulmonary segmentectomy is an important surgical option for complete resection in patients with poor lung function. However, correctly recognizing the intersegmental plane for accurate segmentectomy is sometimes difficult. We therefore developed a novel method that allows the detection of intersegmental planes using an indocyanine green (ICG) fluorescence imaging device, photodynamic eye (PDE) camera, PDE-neo.MethodsAs a prospective study, we performed bronchial ICG-guided segmentectomy using PDE-neo. The patients were placed in a lateral position under general anesthesia, and we performed a combined muscle-sparing minithoracotomy with video assistance. The pulmonary artery, pulmonary vein, and segmental bronchi were separated, and ICG mixed with autologous blood was introduced by spraying through the resected segment bronchi to enable visualization of the intersegmental surface with PDE-neo. This study protocol was approved by the Research Ethics Board of Hamamatsu University School of Medicine, Japan. Written informed consent was obtained from all patients.ResultsOverall, 10 lung malignancy patients, including 8 males and 2 females, participated in this study from March 2011 to October 2013. The median age was 69 years (range, 29–76 years). Pathologic diagnoses were 7 adenocarcinomas, 1 adenosquamous carcinoma, 1 carcinoid tumor, and 1 lung metastasis from the parotid gland cancer. The intersegmental planes of 8 cases could be identified by this method using a PDE-neo, whereas those of 2 cases did not show clear demarcations. The reason was that because of severe emphysema, air flowed from the resected segment to the surrounding segments, obliterating the demarcation between the two segmental planes. There were no recurrent cases and only two deaths due to other diseases were observed; and the 5-year cause-specific survival rate was 100%.ConclusionsIntersegmental planes could be more easily identified using ICG fluorescence imaging during segmentectomy. This method is feasible and effective and has a good long-term prognosis.

Paraneoplastic neurological syndromes with onconeural antibodies: A single center retrospective study

IntroductionParaneoplastic neurological syndromes (PNS) are immune-mediated diseases that occur in patients with tumors and can be associated with onconeural antibodies. Our aim was to describe our cohort of patients with PNS. MethodsRetrospective analysis of a cohort of patients followed in a Portuguese tertiary center, with autoantibodies against intracellular antigens from our PNS panel, between 2012 and 2017. ResultsAmong the 882 patients with suspected PNS (1029 samples), 37 (4.2%) had positive and 27 (3.1%) weak positive antibodies. A total of 17 (29.3%) PNS were diagnosed, 5 were classic syndromes. Autoantibodies found were anti-Yo, anti-Hu, anti-titin, anti-Ma2, anti-SOX1, anti-Ri and anti-CV2/CRMP5. They were associated with thymoma, breast, colon, parotid gland and lung (small-cell, neuroendocrine or carcinoid) cancer. Among the 17 PNS patients, no tumor was found in 4 (mean follow-up of 46 months); no patients improved with tumor treatment, while 8 improved with immunotherapy; ten patients (59%) died during follow-up. Twenty (60.6%) patients with positive antibodies and 21 (84.0%) with weak positive were not diagnosed with a PNS. ConclusionsPNS had highly heterogenous clinical presentations. Response to tumor treatment was overall poor, with an unfavorable prognosis. In our cohort, only 29.3% of the patients with positive antibodies were diagnosed with a PNS.

Clinical-pathological prognostic factors and treatment failure patterns in T1-2 high-grade parotid gland cancer.

The purpose of this study was to evaluate the treatment outcomes of patients with T1-2, high-grade parotid cancer, and to analyze the prognostic factors and treatment failure patterns. Of the 101 patients who were diagnosed with high-grade parotid cancer from March 2003 to December 2018, a total of 39 males and 23 females who had T1-2 tumor were enrolled in this study. The average follow-up period of patients in this study was 63.9months. The 5-year overall survival rate was 73.0%, and the 5-year disease-free survival rate was 57.6%. Thirty-nine patients underwent less-than-total parotidectomies, and the remaining 23 patients underwent total parotidectomies. After surgery, 50 patients received adjuvant treatment. During the study, 25 recurrences were documented, including nine local recurrences and 16 distant metastases. The average time period between the end of initial treatment and disease relapse was 17.0months. A total of 16 patients succumbed to disease progression. Multivariate Cox proportional regression analysis showed that lymphovascular invasion (LVI) was an independent prognostic factor affecting disease recurrence and patient deaths. Among various factors, LVI and lymph node (LN) metastasis showed statistically significant correlations with distant metastasis. Although we achieved favorable therapeutic results using standard treatments in selected patients, T1-2 high-grade parotid cancers generally have poor prognosis. Distant metastases that occur during follow-up are a major factor in treatment failure and LVI and LN metastasis are significantly associated with distant metastasis.

Surgical extent and role of adjuvant radiotherapy of surgically resectable, low-grade parotid cancer.

Due to the rarity of low-grade parotid gland cancer and the diversity of histologic subtype, its optimal treatment modalities and prognostic factors have not been established yet. In this study, we aimed to identify the prognostic factors and adequate treatment modalities for patients with low-grade parotid gland cancer. We retrospectively analyzed clinico-pathologic data from 287 patients with low-grade parotid gland cancer from 1999 to 2018. Recurrence-free survival, disease-specific survival, and overall survival rates at 10years were 80.6%, 93.9%, and 84.4%, respectively. Among all patients, 56.1% received surgery alone, and the remaining 43.9% received surgery with adjuvant radiotherapy. Resection margin status and TNM stage were significant unfavorable prognostic factors. In patients with T1-2 tumor, surgical extent (total vs. less-than-total) did not show any significant effect on disease recurrence and patients' survival, and the disease was controlled well if a negative surgical margin was obtained after surgery, even with microscopic clear margin of<1mm. In patients with adverse pathologic features (positive margin, lymphovascular invasion, perineural invasion, extracapsular nodal spread, T3-4, and N1-3), adjuvant radiotherapy significantly decreased loco-regional recurrence. Oncological outcomes were good in patients with low-grade parotid gland cancer with surgery and radiotherapy. In patients with T1-2 low-grade parotid gland cancer, surgery alone showed good local control rate regardless of the extent of surgery, if a negative surgical margin was obtained after surgery. Adjuvant radiotherapy played a significant role in controlling loco-regional recurrence in patients with adverse pathologic features.

Intraparotid and cervical lymph nodes metastasis in primary parotid gland carcinoma-impact on clinical outcome.

The aim of this study was to investigate the prognostic value of evaluation of intraparotid and cervical lymph node metastases in primary parotid cancer. A retrospective medical chart review and histopathologic evaluation of all patients surgically treated for primary parotid cancer during the period 1993 to 2010 was performed. The presence and ratio of intraparotid and cervical lymph node metastases were assessed and determined as primary predictor variables. Overall survival (OS) and disease-free survival (DFS) were defined as primary outcome variables. In total, 50 patients were included. The presence of pathologic cervical lymph nodes (P=.005) and a high cervical lymph node ratio (LNR) (P=.0001) had a significant association with worse OS. Worse DFS was found in patients with a high cervical LNR (P=.001) and intraparotid lymph node metastases (P=.029). In high-grade carcinoma, a high LNR showed worse DFS (P=.05). A high cervical LNR (P=.012) and resection margin status (P=.002) were identified as independent prognostic markers for OS and the presence of intraparotid lymph nodes for DSS (P=.05). Evaluation of patterns of lymph node metastases provides additional prognostic value in patients with primary parotid gland cancer.

Pure abscopal effect of radiotherapy in a salivary gland carcinoma: Case report, literature review, and a search for new approaches

We report the case of an 84-year-old woman with poorly differentiated non-small cell carcinoma of the right parotid who presented with headache, was found to have a primary right parotid gland cancer as well as metastatic disease, and underwent palliative radiotherapy to the primary site. The patient received no chemotherapy or immunotherapy, but both the primary site and several non-irradiated foci in the lungs regressed or completely resolved. The patient remained free of disease for about one year before progression. The case is a rare instance of abscopal regression of metastatic disease in the absence of pharmacologic immunomodulation. A literature review surveys the history of the abscopal effect of radiation therapy, attempts to understand the mechanisms of its successes and failures, and points to new approaches that can inform and improve the outcomes of radioimmunotherapy.

Trials of a Fluorescent Endoscopic Video System for Diagnosis and Treatment of the Head and Neck Cancer.

This article presents the results of intraoperative fluorescent diagnostics via the endoscopic system for assessing the quality of photodynamic therapy (PDT) of head and neck cancer. The diagnosis and PDT procedures were performed on the five patients with malignant neoplasms of the vocal cords, lateral surface of the tongue, and trachea and cancer of the left parotid salivary gland. Molecular form of chlorin E6 (Ce6) was intravenously administered with a 1.0–1.1 mg/kg concentration for PDT. Fluorescent diagnostics (FD) was conducted before PDT and after PDT procedures. Control of PDT efficiency was carried out by evaluating the photobleaching of the drug (photosensitizer). The method of intraoperative fluorescent imaging allows determining the exact location of the tumor and its boundaries. The assessment of photosensitizer photobleaching in real time regime allows making quick decisions during PDT procedure, which helps improving the quality of patients’ treatment. The results showed the convenience of endoscopic fluorescent video system in various nosologies of head and neck cancer. Therefore, this diagnostic approach will improve the effectiveness of cancer treatment.