Head and Neck Cutaneous Squamous Cell Carcinoma Requiring Parotidectomy: Prognostic Indicators and Treatment Selection

Sweeny, Larissa; Zimmerman, Terence; Carroll, William R.; Schmalbach, Cecelia E.; Day, Kristine E.; Rosenthal, Eben L.

doi:10.1177/0194599814520686

Cited by 38 publications

(78 citation statements)

References 42 publications

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“…5,11,17 Given the increasing incidence of CSCC and the high morbidity and mortality of this disease, more data are needed to help guide adjuvant treatment recommendations to improve survival outcomes. 2,[7][8][9][10]18,19 Our In the present series, patients with tumors with PNI, increased diameter, poor differentiation, or regionally metastatic disease were more likely to undergo adjuvant therapy. Although these findings have been described as high-risk features for CSCC, only PNI and regional disease are currently recognized indications for adjuvant therapy.…”

Section: Discussionmentioning

confidence: 58%

“…7,9,[11][12][13][14][15][16] In advanced disease of the head and neck, factors such as immunosuppression, parotid and cervical nodal disease, and metastatic node size have also been associated with poor outcomes. 8,10,[17][18][19][20] After high-risk features have been identified, the question of which patients benefit from adjuvant therapy remains. Historically, recurrent tumors or tumors with PNI and increased diameter have been treated with postoperative radiation therapy.…”

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confidence: 99%

See 1 more Smart Citation

Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Harris

Pipkorn

Nguyen

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. OBJECTIVE To assess indications for adjuvant radiation therapy in patients with CSCC. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. MAIN OUTCOMES AND MEASURES Data were compared between treatment groups with a χ 2 analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. RESULTS A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. CONCLUSIONS AND RELEVANCE Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.

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Section: Discussionmentioning

confidence: 58%

mentioning

confidence: 99%

Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Harris

Pipkorn

Nguyen

et al. 2019

JAMA Otolaryngol Head Neck Surg

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“…In 75% of patients, the main surgery was total primary resection with reconstruction followed by exenteration and temporalectomies, showing an aggressive presentation, similar to other developing countries 35 . Our data did not find an association between the type of primary surgery and survival, unusual since such a correlation is expected, however, there is comparable studies 34,38,39 .…”

Section: Synopsis Of New Findingssupporting

confidence: 50%

“…The incidence of parotid metastasis from CSCC is not common, occurring in 1% to 5% of all cases of CSCC in the head and neck region and regional metastasis can occur up to five years after resection of the primary 3-5 . The high-risk clinical features for parotid and neck metastasis from CSCC include size (T); depth; scalp, ear pavilion; immunosuppression; recurrence; poor differentiation and others [9][10][11][12] . Recently the immunosuppression induced by drug delivery to organ transplants patients, to those with autoimmune diseases and other clinical comorbidities (diabetes mellitus), has been recognized as an important risk factor for the development of CSCC, with growing incidence and mortality in the world 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of Head and Neck Region

Melo

Guilherme

Gatti

et al. 2020

Preprint

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Objective: To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed cutaneous squamous cell carcinoma (CSCC) of the head and neck region. Study Design: Retrospective cohort study. Setting: Single-center study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Subjects and Methods: Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: overall survival (OS) and disease-specific survival (DSS). Results: The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR=37.6 of positive parotid metastasis evolve into positive neck metastasis, p=0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 and T1, p=0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p=0.016; OS and DSS showed negative survival for the parotid metastasis group, p=0.0283. Conclusion: Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat patients with advanced CSCC of the head and neck region.

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“…Sweeny et al reported on 218 patients with advanced cSCC. Only 81% of these patients had concurrent neck dissection.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous squamous cell carcinoma metastasis to the parotid region lymph nodes

Myers¹,

Ahn

2018

The Laryngoscope

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Objective:To determine the effect on survival of periauricular region cutaneous squamous cell carcinomas (cSCC) metastasizing to parotid region and cervical lymph nodes.Methods: From May 1995 to October 2013, consecutive patients with cSCC undergoing parotidectomy/neck dissection ≥ 18 years without distant metastasis were included. Demographic, clinical, and pathologic data were analyzed. Uniand multivariate analyses of disease-specific survival and overall survival were performed. Statistical significance was set at P < 0.05.Results: We evaluated 137 patients. Most patients were Caucasian males with an average age of 71.6 years. The median follow-up time was 29.4 months. Thirty-six percent of patients had pathological evidence of cervical metastasis (N+). Seven percent had metastasis to level I, 21.9% to level II, 14.6% to level III, 8% to level IV, and 9.5% to level V. Thirty-nine percent of patients had metastasis to parotid region (P+). The average number of positive:total nodes from parotidectomy was 1.9:4.6. The median overall and disease-specific survival times were 2.81 and 1.96 years, respectively. Patients with either neck or parotid metastasis (N + or P+) had significantly decreased survival, hazard ratio 2.298 (1.2739, 4.1445), compared to patients without metastasis (N0P0), P < 0.0057.Conclusion: Patients with periauricular region cSCC metastasizing to parotid and cervical regions lymph nodes have significantly decreased survival compared with patients without cervical and/or parotid metastasis. Metastasis to parotid region should be considered as a distinct head and neck level when staging periauricular cancers. This study provides a basis for further studies to validate these findings.

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Head and Neck Cutaneous Squamous Cell Carcinoma Requiring Parotidectomy: Prognostic Indicators and Treatment Selection

Cited by 38 publications

References 42 publications

Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of Head and Neck Region

Cutaneous squamous cell carcinoma metastasis to the parotid region lymph nodes

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