Intermediate-grade carcinoma of the parotid and the impact of adjuvant radiation

Lauren North, Michael Stadler, Becky Massey, Bruce Campbell, Monica Shukla, Musaddiq Awan, Christopher J. Schultz, Aditya Shreenivas, Stuart Wong, Evan Graboyes, Patrick Pipkorn, Joseph Zenga

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To determine the influence of adjuvant radiotherapy on survival in surgically-managed early stage intermediate-grade mucoepidermoid and acinic cell carcinoma of the parotid. Materials and methods: The National Cancer Database was reviewed between 2004 and 2015 to identify patients with intermediate-grade, early T-stage, node-negative parotid carcinoma who underwent parotidectomy ± radiotherapy. Results: There were 744 patients identified of which 81% had mucoepidermoid carcinoma and 19% had acinic cell carcinoma. Positive surgical margins were identified in 21% and adjuvant radiotherapy was administered in 38% of cases. Of the 159 patients with positive margins, 113 (71%) received adjuvant radiotherapy. Of the 585 patients with negative margins, 173 (30%) underwent adjuvant radiotherapy. In multivariable analysis, age (over 52 years: HR 5.19, 95%CI 2.33–11.57), insurance status (private insurance: HR 0.24 95%CI 0.13–0.43), and extent of parotidectomy (total parotidectomy: HR 2.02 95%CI 1.23–3.31) were significantly associated with overall survival, while adjuvant radiotherapy was not a significant predictive factor (HR 0.81, 95%CI 0.49–1.36). In patients with positive margin resections, however, adjuvant radiation was an independent predictor of improved survival when adjusted for age, insurance status, and extent of parotidectomy (HR 0.34, 95%CI 0.13–0.88). Conversely, in patients with negative margin resections, adjuvant radiation did not influence survival outcomes when adjusted for these covariates (HR 1.02, 95%CI 0.53–1.93). Conclusions and relevance: In patients with early stage intermediate-grade parotid carcinoma, adjuvant radiotherapy significantly and independently improves survival in those with post-operative positive margins. Adjuvant therapy, however, does not appear to improve survival outcomes in those with negative margin resections.

Original languageEnglish
Article number102282
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume40
Issue number6
DOIs
StatePublished - Nov 1 2019

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