Recurrence in region of spared parotid gland after definitive intensity-modulated radiotherapy for head and neck cancer.
OBJECTIVE
To discuss the implications of three examples of periparotid recurrence after definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC).


METHODS
We present 3 patients with HNC who underwent definitive IMRT with concurrent chemotherapy and later had treatment failure in or near a spared parotid gland. Two patients had bilateral multilevel nodal disease, and all had Level II nodal disease ipsilateral to the site of recurrence. The patients were treated using dose-painting IMRT with a dose of 70 Gy to the gross tumor volume and 59.4 Gy or 54 Gy to the high-risk or low-risk clinical tumor volume, respectively. The parotid glands were spared bilaterally. The patients had not undergone any surgical treatment for HNC before radiotherapy.


RESULTS
All patients had treatment failure in the region of a spared parotid gland. Failure in the 2 patients with bilateral multilevel nodal involvement occurred in the periparotid lymph nodes. The third patient developed a dermal metastasis near the tail of a spared parotid gland. On pretreatment imaging, the 2 patients with nodal failure had small nonspecific periparotid nodules that showed no hypermetabolic activity on positron emission tomography.


CONCLUSIONS
For HNC patients receiving definitive IMRT, nonspecific positron emission tomography-negative periparotid nodules on pretreatment imaging should raise the index of suspicion for subclinical disease in the presence of multilevel or Level II nodal metastases. Additional evaluation of such nodules might be indicated before sparing the ipsilateral parotid gland.
Weill-Cornell Medical College, New York, NY, USA.
Donald M
DM
Cannon
Nancy Y
NY
Lee
D002277:Carcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D010306:Parotid Gland / Q000528:radiation effects / Q000601:surgery; D011832:Radiation Injuries / Q000517:prevention & control; D011877:Radionuclide Imaging; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000556:secondary; D014067:Tonsillar Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D017211:Treatment Failure