Outcomes of Temporal Bone Resection for Locally Advanced Parotid Cancer

ABSTRACT

This study was conducted to report outcomes and identify factors predictive of survival and recurrence in patients undergoing lateral temporal bone resection (LTBR) as part of an extended radical parotidectomy for parotid cancer. This is a retrospective cohort study which includes all patients undergoing LTBR for parotid cancer between 1994 and 2010 at two affiliated academic centers. Survival and recurrence rates were analyzed using the Kaplan-Meier method and Cox multivariate regression. A total of 12 patients with median follow-up duration of 30.6 months were included: 6 de novo cases and 6 patients referred after local recurrence. Actuarial locoregional control at 2 years was 73%. Most patients (11; 92%) developed disease recurrence with distant metastases the most common site of first failure (83%). Overall and disease-specific survival rates were 80% at 2 years and 22.5% at 5 years. Recurrence-free survival (RFS) was 67% at 2 years and 8.3% at 5 years. On multivariate analysis, surgical margin status was an independent predictor of RFS (hazard ratio = 3.85, p = 0.045). In advanced parotid cancer, LTBR with a goal of gross total resection offers good locoregional control with an acceptable complication rate. The benefits of this surgery must be balanced with the morbidity and low likelihood of long-term survival, with most patients ultimately experiencing disease recurrence and death.

KEYWORDS

Temporal bone resection - parotid cancer - outcomes

REFERENCES

• 1 National Cancer Institute. Cancer Incidence: Surveillance Epidemiology and End Result 17. 2010: Bethesda, MD.
• 2 Spiro R H, Armstrong J, Harrison L, Geller N L, Lin S Y, Strong E W. Carcinoma of major salivary glands. Recent trends.  Arch Otolaryngol Head Neck Surg. 1989;  115 (3) 316-321
• 3 Armstrong J G, Harrison L B, Spiro R H, Fass D E, Strong E W, Fuks Z Y. Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy.  Arch Otolaryngol Head Neck Surg. 1990;  116 (3) 290-293
• 4 Spiro R H. Management of malignant tumors of the salivary glands.  Oncology (Williston Park). 1998;  12 (5) 671-680 discussion 683 (Williston Park)
• 5 Noh J M, Ahn Y C, Nam H et al. Treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy.  Clin Exp Otorhinolaryngol. 2010;  3 (2) 96-101
• 6 Kane W J, McCaffrey T V, Olsen K D, Lewis J E. Primary parotid malignancies. A clinical and pathologic review.  Arch Otolaryngol Head Neck Surg. 1991;  117 (3) 307-315
• 7 Jeannon J P, Calman F, Gleeson M et al. Management of advanced parotid cancer. A systematic review.  Eur J Surg Oncol. 2009;  35 (9) 908-915
• 8 Frankenthaler R A, Luna M A, Lee S S et al. Prognostic variables in parotid gland cancer.  Arch Otolaryngol Head Neck Surg. 1991;  117 (11) 1251-1256
• 9 Leonetti J P, Smith P G, Anand V K, Kletzker G R, Hartman J M. Subtotal petrosectomy in the management of advanced parotid neoplasms.  Otolaryngol Head Neck Surg. 1993;  108 (3) 270-276
• 10 Allen G W. Anew technique employing partial temporal bone resection in parotid gland surgery for cancer.  Surg Clin North Am. 1966;  46 (1) 131-143
• 11 Voss P J, Leow A M, Schulze D, Metzger M C, Liebehenschel N, Schmelzeisen R. Navigation-guided resection with immediate functional reconstruction for high-grade malignant parotid tumour at skull base.  Int J Oral Maxillofac Surg. 2009;  38 (8) 886-890
• 12 Leonetti J P, Marzo S J, Agarwal N. Adenoid cystic carcinoma of the parotid gland with temporal bone invasion.  Otol Neurotol. 2008;  29 (4) 545-548
• 13 De Vincentiis M, Magliulo G, Soldo P et al. Extended parotidectomy.  Acta Otorhinolaryngol Ital. 2005;  25 (3) 169-173
• 14 Edge S B, Byrd R D, Caruosi M, Compton C C, Fritz A G. Major salivary glands (Chapter 7). In: AJCC Cancer Staging Manual, 7th ed. New York: Springer; 2010: 80
• 15 Reddy S P, Marks J E. Treatment of locally advanced, high-grade, malignant tumors of major salivary glands.  Laryngoscope. 1988;  98 (4) 450-454
• 16 Kobayashi K, Nakao K, Yoshida M et al. Recurrent cancer of the parotid gland: how well does salvage surgery work for locoregional failure?.  ORL J Otorhinolaryngol Relat Spec. 2009;  71 (5) 239-243
• 17 Kwok H C, Morton R P, Chaplin J M, McIvor N P, Sillars H A. Quality of life after parotid and temporal bone surgery for cancer.  Laryngoscope. 2002;  112 (5) 820-833