title: Analysis of rare periparotid recurrence after parotid gland-sparing intensity-modulated radiotherapy for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  Periparotid recurrence is an uncommon phenomenon after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. This study aimed to discuss the clinical characteristics, reasonable causes and feasible therapeutic modalities of patients with nasopharyngeal carcinoma and periparotid recurrence.
  
  
  METHODS
  The medical records of 1852 patients with non-metastatic nasopharyngeal carcinoma treated with initial IMRT between January 2008 and December 2012 were retrospectively reviewed, and nine patients were finally found to have developed periparotid recurrence after IMRT. After periparotid failure, four received radiotherapy and chemotherapy, two had surgery, two had surgery and adjuvant radiotherapy or chemotherapy, and one received radiotherapy alone.
  
  
  RESULTS
  The incidence rate of periparotid recurrence was 4.9‰. According to pretreatment magnetic resonance imaging (MRI) scans, all patients had both ipsilateral retropharyngeal lymph nodes metastasis with 66.7% of extracapsular spread and level II lymphadenopathy with all extracapsular spread. The median time interval to periparotid failure was 14.8 months, and six patients were found to have a relapse in the primary sites of unsuspicious parotid nodules. After a median follow-up of 46.4 months, five patients developed distant metastasis, three of them developed local failure. In addition, one developed regional failure, one developed locoregional recurrence, and only one was alive without evidence of disease at the last follow-up.
  
  
  CONCLUSIONS
  Periparotid recurrences are rare after definitive IMRT for nasopharyngeal carcinoma. However, patients with ipsilateral retropharyngeal lymph nodes or level II nodal extracapsular spread on pretreatment MRI could be suspicious of metastatic periparotid nodules. Distant metastases were the main treatment failure despite a combination of several salvage treatment of periparotid recurrence. More effective chemotherapy should be explored.
authors.affiliation: The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.affiliation: The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
authors.forename: M
authors.initials: M
authors.lastname: Zhang
authors.affiliation: The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
authors.forename: Q
authors.initials: Q
authors.lastname: Yue
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Zong
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Lin
authors.affiliation: Radiation Oncology Department, Gustave-Roussy Cancer Campus, Université Paris-Sud, 94805 Villejuif cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Sun
authors.affiliation: The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China.
authors.forename: S
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China.
authors.forename: S
authors.initials: S
authors.lastname: Lin
authors.affiliation: The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China. Electronic address: panjianji@aliyun.com.
authors.forename: J
authors.initials: J
authors.lastname: Pan
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D059351:Organ Sparing Treatments; D010306:Parotid Gland / Q000473:pathology*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016879:Salvage Therapy; D055815:Young Adult
keywords: Carcinome nasopharyngé; Chemotherapy; Chimiothérapie; Distant metastasis; Intensity-modulated radiotherapy; Métastases à distance; Nasopharyngeal carcinoma; Periparotid recurrence; Radiothérapie avec modulation d’intensité; Récidives périparotidiennes