Treatment Options after Total Parotidectomy
Dear OncoLink "Ask the Experts,"
My husband has just had a total parotidectomy (L) where facial nerves had been sacrificed. The histopathology says that what he has is a high-grade mucoepidermoid carcinoma. The tumor extracted from him was 6 cm in size. We were told that he's in stage 3.
Please tell us the possible treatments thereafter. The doctor is still having second thoughts about radiotherapy alone. He's considering a combination treatment of chemo and radiation after consulting with another doctor. Please send us more information about the pros and cons of having irradiation alone versus having a combination of treatments.
Please enlighten us on this matter.
Li Liu, MD, OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
The generally accepted indications of postoperative radiation therapy for parotid cancer include gross or microscopic residual, recurrent, high-grade and advanced-stage (stage III and IV) cancers. To my knowledge, there have been no randomized studies comparing surgery alone with surgery plus radiation therapy. Some retrospective studies demonstrated improved local control as well as survival of the patients treated with surgery plus radiation therapy. In general, mucoepidermoid and acinic cell carcinomas appear to have better prognosis than other histologic subtypes (Spiro RH, et al. Head and Neck surgery, 1986, 7:177). However, high-grade mucoepidermoid carcinomas may behave just like other high-grade malignancies, such as adenoid cystic carcinoma, adenocarcinoma, squamous, and undifferentiated carcinomas.
The most commonly observed side effects of radiation therapy to this region include skin reaction, dry mouth (xerostomia) and difficulty of opening the mouth (trismus). Radiation induced second malignancies may also be of major concern, especially for younger patients.
The use of chemotherapy for parotid cancer remains controversial. Chemotherapy is more often used in patients with recurrent, metastatic, and/or inoperable tumors than in the adjuvant settings. Administration of chemotherapy has its own toxicities, which vary based on the drugs being considered. If chemotherapy is being given at the same time as radiation therapy, the effects of radiation on mucosa and skin are enhanced. While a combination of treatments may be advantageous over radiation therapy alone, there is very little experience with this in parotid cancers.
You should discuss his case with surgeon, radiation oncologist as well as medical oncologist.