Abstract
Purpose
In this study we review our institution’s experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies.
Methods
Patients undergoing lateral temporal bone resection and parotidectomy from 2007–2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively.
Results
Fifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series.
Conclusion
Local and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control.
1
Introduction
Salivary malignancies account for approximately 6% of head and neck malignancies; the incidence is 1.5/100,000, the 5-year survival rate is 75–80%, and the 10-year survival rate is 65–70% . Surgical resection with postoperative radiation therapy for advanced stage or high-grade tumors is the standard of care. Prognosis and recurrence of parotid cancer are significantly varied by several factors including histologic grade, T stage, nodal status, and the use of adjuvant radiation therapy . Despite an overall excellent prognosis, the recurrence rate is 21–33% .
Locally advanced parotid malignancy typically present with pain, a mass, facial palsy, hearing loss, trismus, and/or ear drainage. In the case of locally advanced disease, more aggressive approaches have been described . Extended resection techniques may require removal of the skin, facial nerve, or mandible. In cases with tumor invading or abutting the temporal bone, a lateral temporal bone resection can enable complete tumor resection, access to the deeper margin of tumor, and the ability to take a proximal facial nerve margin. A paucity of literature in this area shows a fundamental lack of understanding of outcomes of temporal bone resection for of locally advanced parotid malignancies. The largest retrospective review of 12 patients undergoing temporal bone resection for parotid malignancy showed 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 . More evidence is necessary to help accurately drive clinical judgment and allow for educated weighing of risks versus benefits.
The aim of this study is to review our institution’s experience and outcomes with lateral temporal bone resection and parotidectomy in the treatment of locally advanced temporal bone malignancies.
2
Materials and methods
Patients for inclusion in our study were identified by searching the EPIC electronic medical record at Loyola University Medical Center for patients that underwent combined parotidectomy and temporal bone resection. Search was conducted from 2007, the start of EPIC electronic medical record at our institution, to 2013 to allow for at least 2 years of follow up after surgery. Twenty-nine patients were identified who underwent combined parotidectomy and temporal bone resection. Of these 29 patients, 15 had a parotid malignancy. The other 14 patients had primary temporal bone, ear canal, or auricular malignancies.
Patient, pathologic, treatment, and outcome data was collected from the medical record. Collected data included: age, gender, tumor histology, tumor location, facial nerve function, nodal status, margin status, perineural invasion, nerve sacrifice, staging, adjuvant treatments, presence of recurrence, and date of death.
Surgical treatment for all patients included total parotidectomy, lateral temporal bone resection, and ipsilateral neck dissection. Based on the extent of the tumor, some patients required extended resections including facial nerve sacrifice, mandibulectomy, auriculectomy, skin resection, dural resection, or a free or pedicled flap reconstruction.
2
Materials and methods
Patients for inclusion in our study were identified by searching the EPIC electronic medical record at Loyola University Medical Center for patients that underwent combined parotidectomy and temporal bone resection. Search was conducted from 2007, the start of EPIC electronic medical record at our institution, to 2013 to allow for at least 2 years of follow up after surgery. Twenty-nine patients were identified who underwent combined parotidectomy and temporal bone resection. Of these 29 patients, 15 had a parotid malignancy. The other 14 patients had primary temporal bone, ear canal, or auricular malignancies.
Patient, pathologic, treatment, and outcome data was collected from the medical record. Collected data included: age, gender, tumor histology, tumor location, facial nerve function, nodal status, margin status, perineural invasion, nerve sacrifice, staging, adjuvant treatments, presence of recurrence, and date of death.
Surgical treatment for all patients included total parotidectomy, lateral temporal bone resection, and ipsilateral neck dissection. Based on the extent of the tumor, some patients required extended resections including facial nerve sacrifice, mandibulectomy, auriculectomy, skin resection, dural resection, or a free or pedicled flap reconstruction.
3
Results
3.1
Patient characteristics and staging
Our review of 29 patients who underwent combined parotidectomy and temporal bone resection between 2007 and 2013 included 15 patients with a parotid malignancy. All patients had at least 2 years of clinical follow up or were deceased. The mean follow up was 34.8 months. Patients ranged in age from 39 to 85 with a mean of 64 years. Sixty percent of our patients were male ( Table 1 ).
