Contemporary Management of Benign and Malignant Parotid Tumors

Abstract

To report the standard of care, interesting new findings and controversies about the treatment of parotid tumors.Relevant and actual studies were searched in PubMed and reviewed for diagnostics, treatment and outcome of both benign and malignant tumors.Prospective trials are lacking due to rarity of the disease and high variety of tumor subtypes.The establishment of reliable non-invasive diagnostics tools for the differentiation between benign and malignant tumors is desirable. Prospective studies clarifying the association between different surgical techniques for benign parotid tumors and morbidity are needed. The role of adjuvant or definitive radiotherapy in securing loco-regional control and improving survival in malignant disease is established. Prospective clinical trials addressing the role of chemotherapy/molecular targeted therapy for parotid cancer are needed. An international consensus on the classification of parotid surgery techniques would facilitate the comparison of different trials. Such efforts should lead into a clinical guideline.

MAML2 rearrangement as a useful diagnostic marker discriminating between Warthin tumour and Warthin-like mucoepidermoid carcinoma

“…Current guidelines indicate the resection for all parotid gland tumours; for Warthin tumours, partial or superficial resection is preferred whenever possible; however, wait-and-scan strategy is sometimes postulated [36,37]. On the other hand, total parotidectomy, often accompanied by some degree of neck dissection, is the treatment of choice for MEC; in cases with positive margins or high-grade histology, adjuvant radiotherapy should also be considered [36,38]. In this context, the recently recognized Warthin-like MEC may be particularly problematic.…”

The diagnostic value of cytology in parotid Warthin's tumors: international multicenter series

“…9 In general, there is consensus among clinicians that an observational strategy is not appropriate when a pleomorphic adenoma is suspected, due to the small but cumulative risk of malignant transformation and continued tumor growth over time. 13 The aim of this study is to analyze concordance between the cytological and histological findings of parotid lesions, specifically those that have been diagnosed as WT on cytology, and to compare the risks of surgery with the possible risks of a policy of observation in cases of cytological diagnosis of WT. Observation is generally proposed in asymptomatic cases or if the surgical procedure represents an unacceptable risk for the patient compared to the benign and indolent nature of the tumor itself.…”

“…Observation is generally proposed in asymptomatic cases or if the surgical procedure represents an unacceptable risk for the patient compared to the benign and indolent nature of the tumor itself. 13 The aim of this study is to analyze concordance between the cytological and histological findings of parotid lesions, specifically those that have been diagnosed as WT on cytology, and to compare the risks of surgery with the possible risks of a policy of observation in cases of cytological diagnosis of WT.…”

A nomogram to estimate the risk of developing distant metastases in parotid cancer

“…36,39,40 Nowadays, salvage surgery for DM maintains a niche indication and metastasectomy remains so far the only local effective therapy for ACC disseminated to the lungs. 6,41 A recent study has clarified that the advantage in terms of prognosis exists only when complete resection is performed (regardless of the number and the site of lung lesions) and the time to appearance of DM after primary resection is >36 months. 41 In our series, we have shown a similar trend in terms of late-onset DM but, for ACC cases only, we could not find a significant difference (log-rank test for 36 months, P = .92).…”

“…[3][4][5] It is currently established that PC management is chiefly surgical with adjuvant radiation therapy (RT) in most cases. 6 It is crucial for surgery to be performed in a high-volume facility in order to obtain a margin-free resection because it has been recently highlighted how this have a tremendous impact on prognosis. 7 At present, while the optimal management of locoregional disease and facial nerve has reached a large consensus in the literature, we continue to suffer the lack of effective systemic therapy.…”