Outcomes of cutaneous squamous cell carcinoma of the head and neck with parotid metastases

Abstract

Despite multimodality treatment metastatic cHNSCC involving the parotid shows moderate rates of recurrence. Immunosuppressed patients with this disease have a particularly poor prognosis, demonstrating lower rates of CSS with similar rates of LRC compared to their immunocompetent counterparts.

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

“…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.…”

“…3 In general, cure rates exceed 90% with early-stage disease [4][5][6] ; however, patients with locally advanced or regionally metastatic disease have higher rates of recurrence, with some reported 5-year overall survival (OS) estimates less than 50%. [7][8][9][10] Optimal treatment of advanced CSCC remains controversial because there are only a few large retrospective series that describe clinical outcomes, and no randomized clinical trials are available to guide decision making. Dermatologic series for all CSCCs have demonstrated that tumor differentiation, diameter, depth of invasion, and perineural invasion (PNI) are indicative of recurrence and poor survival.…”

“…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.…”

High‐Risk Cutaneous Squamous Cell Cancer of the Head and Neck: Risk Factors for Recurrence and Impact of Adjuvant Treatment

“…Those are based mostly on single-institution reviews, as there are no national cancer registries that currently track the outcomes of cSCC. Risk factors for HNcSCC reportedly associated with worse outcomes include: advanced age, 6,7 size/diameter, 4,5,8,9 depth of invasion, 4,5,9 perineural invasion (PNI), 4,5,10,11 location, 5 poorly differentiated histology, 4,5,9,12,13 recurrent disease, 4 extranodal extension (ENE) of lymph nodes, 7,8,14,15 lymph node ratio, 6,16,17 immunosuppression, 6,11,[14][15][16][18][19][20] positive margins, 13,15,19,21 parotid metastases, 19,22 and disease-free interval. 23 Although many of these have been taken into consideration in the American Joint Committee on Cancer (AJCC) 8th Edition staging of HNcSCC, several others have been omitted.…”

Treatment Package Time in Node-Positive Cutaneous Head and Neck Squamous Cell Carcinoma

“…Patients with cutaneous squamous cell carcinoma (SCC) of the head and neck (cHNSCC) with metastases to the parotid gland or deep cervical lymph nodes are considered to be at moderate risk of locoregional failure and death. [1][2][3][4] Postoperative radiation therapy (PORT) is considered the standard of care in these patients because the available data suggests an improvement in locoregional control and survival. 5,6 In mucosal HNSCC (mHNSCC), prolongation of treatment package time (TPT -the interval between date of surgery and completion of PORT) beyond 11 to 14 weeks reduces both locoregional control and overall survival.…”