Dear OncoLink "Ask the Experts,"
Would you please clarify the details of the latest treatment options for mucoepidermoid carcinoma of the parotid gland? The patient in question is a female of 35 years of age. Her disease is grade I and recurrent in nature. Also, could you please clarify the role of selective radiotherapy in this case.
Li Liu, MD, OncoLink Editorial Assistant, responds:
Dear Dr. MP,
Thank you for your question and interest.
Mucoepidermoid carcinoma has a broad spectrum of aggressiveness, from low grade tumors that primarily cause local problems to high grade tumors that unfortunately can have a very low survival rate. The most important prognosticators are age, tumor size and histology (high mitotic figures, neural involvement, necrosis, and anaplasia).
The indications for radiation therapy for mucoepidermoid carcinoma of the parotid are:
The experience from Memorial Sloan-Kettering Cancer Center indicated that patients with positive nodes and/or stage III or IV disease benefitted from post-operative radiation therapy the most with significantly better loco-regional control and overall survival than a matched cohort of historical controls. A smaller series from Johns Hopkins reported that in patients presenting with recurrent disease, 4/4 (100%) failed locally following surgery alone as opposed to 3/14 (21%) following surgery plus postoperative RT (p = 0.01).
- Microscopic or macroscopic residual disease
- Recurrent cancer
- Advanced primary tumor stage (facial nerve involvement, cervical lymphadenopathy, high grade histology, and deep lobe involvement)
- Contamination of surgical bed at the time of resection
In addition to external beam radiation alone, intraoperative brachytherapy plus postoperative external beam radiation is also used to improve local control. A consultation from a radiation oncologist is warranted in this case.