title: Intraoperative radiotherapy for parotid cancer: a single-institution experience.
abstract: OBJECTIVE
  Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland.
  
  
  METHODS
  Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years.
  
  
  RESULTS
  Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT.
  
  
  CONCLUSIONS
  IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.
authors.affiliation: Department of Radiation Oncology, Methodist Hospital, Indianapolis, IN, USA. youssefzaidan@gmail.com
authors.forename: Youssef H
authors.initials: YH
authors.lastname: Zeidan
authors.forename: Kevin
authors.initials: K
authors.lastname: Shiue
authors.forename: Daniel
authors.initials: D
authors.lastname: Weed
authors.forename: Peter A
authors.initials: PA
authors.lastname: Johnstone
authors.forename: Colin
authors.initials: C
authors.lastname: Terry
authors.forename: Stephen
authors.initials: S
authors.lastname: Freeman
authors.forename: Edward
authors.initials: E
authors.lastname: Krowiak
authors.forename: Robert
authors.initials: R
authors.lastname: Borrowdale
authors.forename: Tod
authors.initials: T
authors.lastname: Huntley
authors.forename: Alex
authors.initials: A
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007196:Indiana; D007430:Intraoperative Care / Q000379:methods*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D018365:Neoplasm, Residual; D058958:Organs at Risk / Q000528:radiation effects; D010307:Parotid Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000150:complications / Q000517:prevention & control; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D055815:Young Adult