Youssef Zeidan MD, PhD, Presenter: Nothing to Disclose

Alexander M. Yeh MD, Abstract Co-Author: Nothing to Disclose

Peter Johnstone, Abstract Co-Author: Nothing to Disclose

Stephen Freeman, Abstract Co-Author: Nothing to Disclose

Daniel William Weed MD, Abstract Co-Author: Nothing to Disclose

Tod Huntley, Abstract Co-Author: Nothing to Disclose

Kevin Shiue, Abstract Co-Author: Nothing to Disclose

Our practice policy has been to provide intraoperative radiation therapy (IORT) at the time of resection to patients with head and neck malignancies considered to be at high risk of recurrence. The purpose of this study is to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland.  

Between 1982 and 2007, 128 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. Median age was 66.9 years, with a range of 14.3 to 97.0 years. Thirty-three patients had previously been treated with external beam radiation therapy (EBRT) as a component of definitive therapy. Forty-six patients had positive margins after surgery, and 48 had perineural invasion. IORT was administered as a single fraction to a median dose of 1500 cGy (range, 1000 to 2500 cGy) with 4 to 6 MeV electrons. Median follow-up was 44 months.  

1, 3, and 5 years overall survival (OS) for post-salvage surgery and IORT were 83.6%, 59.9%, and 48.7%, respectively. Recurrence-free survival estimates for 1, 3, and 5 years post-salvage surgery and IORT were 76.2%, 62.4%, and 59.7%, respectively. Only 2 patients experienced local recurrence. Twenty-eight patients experienced regional recurrences and 17 patients experienced distant recurrences. There were no perioperative fatalities. Complications occurred in 36 individual patients and included fistulas (4 patients), flap necrosis (4 patients), wound dehiscence (2 patients), trismus (6 patients), neuropathy (1 patient), radiation osteonecrosis (5 patients), vascular complications (9 patients), and other complications (27 patients). Seventeen of these 36 patients had recurrent disease. Eight of these patients had EBRT prior to treatment with IORT.  

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.  

The current study constitutes the largest experience using IORT for managing parotid tumors.

Zeidan, Y, Yeh, A, Johnstone, P, Freeman, S, Weed, D, Huntley, T, Shiue, K, Intraoperative Radiation Therapy for Parotid Cancer: A Single Institution Experience.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003091.html