Facial nerve sacrifice and radiotherapy in parotid adenoid cystic carcinoma.
OBJECTIVE
To evaluate the impact of facial nerve sacrifice and postoperative radiotherapy on the outcome of adenoid cystic carcinoma of the parotid gland.


METHODS
Inception cohort.


METHODS
Retrospective review of Department of Pathology, SNOMED database, and Tumor Registry including health-related quality of life data for the subset enrolled in the longitudinal Outcomes Assessment Project. Fisher exact, chi, and Wilcoxon tests were used to determine significant differences.


RESULTS
Fifty-two cases (follow-up mean: 9.1 years, range: 0.5-40.8 years) demonstrated local control rates of 84.6% (5 years), 76.9% (10 years), and 50% (20 years). Compared with facial nerve preservation, facial nerve sacrifice had better control at 5 years (100 vs. 78.9% P = .259) while having detrimental effects on eating, speech, and esthetics. Local control at 5 years was significantly better (P = .048) with postoperative radiotherapy (100%) than without (84.6%). Overall survival was 79.4% (5 years), 50% (10 years), and 32.3% (20 years). At 10 years, there was a trend toward improved survival with facial nerve sacrifice (58.8 vs. 46.8%, P = .569) and postoperative radiotherapy (62.4 vs. 39.3%, P = .409). Eleven patients with lung metastases survived an average of 67.8 months after metastases were identified. Only 4 of 46 patients N0 patients (8.3%) subsequently developed lymph node metastases.


CONCLUSIONS
Selective facial nerve sacrifice was associated with trends toward improved local control and survival but worse quality of life. Patients managed with postoperative radiotherapy had better local control rates than those without. N0 patients rarely developed metastases to regional lymph nodes.
Iseli
Tim A
TA
Department of Otolaryngology Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242 , USA.
Karnell
Lucy H
LH
Preston
Todd W
TW
Graham
Scott M
SM
Funk
Gerry F
GF
Buatti
John M
JM
Gupta
Anjali K
AK
Robinson
Robert A
RA
Hoffman
Henry T
HT