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Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes.
Laryngoscope. 2008 Nov; 118(11):1989-96.L

Abstract

INTRODUCTION

Metastatic spread to parotid-area lymph nodes (PALN) occurs in 1% to 3% of patients with cutaneous squamous cell carcinoma of the head and neck. Presented herein is the University of Florida experience using radiation therapy (RT) to treat patients with PALN metastases from a skin primary.

METHODS AND MATERIALS

From November 1969 to February 2005, 121 parotids in 117 patients received irradiation for nonmelanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone.

RESULTS

Five-year actuarial probabilities of local (parotid) control, local-regional control, disease-free survival and overall survival were 78%, 74%, 70%, and 54%, respectively. When patients were separated by O'Brien P-stage, statistically significant differences were seen among the groups for local (parotid) control, local-regional control, and disease-free survival. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%) and in local-regional control for patients treated with preoperative RT or RT alone when compared with postoperative RT (59% and 47% vs. 83%, respectively). The 5-year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications.

CONCLUSIONS

PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local-regional control and disease-free survival. Patients treated with preoperative RT seem to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon after surgery and RT for PALN metastases.

Authors+Show Affiliations

Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA. hinerw@shands.ufl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18849863

Citation

Hinerman, Russell W., et al. "Cutaneous Squamous Cell Carcinoma Metastatic to Parotid-area Lymph Nodes." The Laryngoscope, vol. 118, no. 11, 2008, pp. 1989-96.
Hinerman RW, Indelicato DJ, Amdur RJ, et al. Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes. Laryngoscope. 2008;118(11):1989-96.
Hinerman, R. W., Indelicato, D. J., Amdur, R. J., Morris, C. G., Werning, J. W., Vaysberg, M., Kirwan, J., & Mendenhall, W. M. (2008). Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes. The Laryngoscope, 118(11), 1989-96. https://doi.org/10.1097/MLG.0b013e318180642b
Hinerman RW, et al. Cutaneous Squamous Cell Carcinoma Metastatic to Parotid-area Lymph Nodes. Laryngoscope. 2008;118(11):1989-96. PubMed PMID: 18849863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cutaneous squamous cell carcinoma metastatic to parotid-area lymph nodes. AU - Hinerman,Russell W, AU - Indelicato,Daniel J, AU - Amdur,Robert J, AU - Morris,Christopher G, AU - Werning,John W, AU - Vaysberg,Mikhail, AU - Kirwan,Jessica, AU - Mendenhall,William M, PY - 2008/10/14/pubmed PY - 2008/11/19/medline PY - 2008/10/14/entrez SP - 1989 EP - 96 JF - The Laryngoscope JO - Laryngoscope VL - 118 IS - 11 N2 - INTRODUCTION: Metastatic spread to parotid-area lymph nodes (PALN) occurs in 1% to 3% of patients with cutaneous squamous cell carcinoma of the head and neck. Presented herein is the University of Florida experience using radiation therapy (RT) to treat patients with PALN metastases from a skin primary. METHODS AND MATERIALS: From November 1969 to February 2005, 121 parotids in 117 patients received irradiation for nonmelanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone. RESULTS: Five-year actuarial probabilities of local (parotid) control, local-regional control, disease-free survival and overall survival were 78%, 74%, 70%, and 54%, respectively. When patients were separated by O'Brien P-stage, statistically significant differences were seen among the groups for local (parotid) control, local-regional control, and disease-free survival. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%) and in local-regional control for patients treated with preoperative RT or RT alone when compared with postoperative RT (59% and 47% vs. 83%, respectively). The 5-year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications. CONCLUSIONS: PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local-regional control and disease-free survival. Patients treated with preoperative RT seem to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon after surgery and RT for PALN metastases. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/18849863/Cutaneous_squamous_cell_carcinoma_metastatic_to_parotid_area_lymph_nodes_ L2 - https://doi.org/10.1097/MLG.0b013e318180642b DB - PRIME DP - Unbound Medicine ER -