title: Malignant epithelial parotid gland tumours: analysis and results in 65 previously untreated patients.
abstract: BACKGROUND
  Optimal management of malignant epithelial parotid tumours requires knowledge of the available therapeutic modalities and the different biological characteristics. The aim of the study was to review the characteristics of patients at presentation, histological classification, disease-free and overall survival rates, and the results of the applied treatment policy regarding the facial nerve and neck.
  
  
  METHODS
  Between 1974 and 1995 a total of 65 patients was treated with curative intent for a previously untreated malignant epithelial parotid gland tumour. All patients underwent some type of parotidectomy, 20 of whom had an en bloc radical neck dissection. In selected cases the facial nerve or its branches were peeled off the tumour thus violating the objective of tumour-free margins and relying heavily on the efficacy of postoperative radiotherapy. In total 51 patients received postoperative radiotherapy. None of the patients was lost to follow-up.
  
  
  RESULTS
  There were 12 locoregional failures (18 per cent). In only one of these 12 patients was salvage therapy successful; the remaining 11 patients died from the tumour. All but one of the eight patients with distant metastasis only died from the tumour. The estimated 5- and 10-year disease-free rates were 68 and 59 per cent respectively. The corresponding survival rates were 75 per cent and 67 per cent. A significant relationship could be observed between tumour stage and survival. The presence of lymph node metastases proved to be the strongest single prognostic factor.
  
  
  CONCLUSIONS
  In selected cases a conservative approach towards the facial nerve is justified.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Leverstein
authors.forename: J E
authors.initials: JE
authors.lastname: van der Wal
authors.forename: R M
authors.initials: RM
authors.lastname: Tiwari
authors.forename: H
authors.initials: H
authors.lastname: Tobi
authors.forename: I
authors.initials: I
authors.lastname: van der Waal
authors.forename: D M
authors.initials: DM
authors.lastname: Mehta
authors.forename: G B
authors.initials: GB
authors.lastname: Snow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D005155:Facial Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome