Zenga Joseph, Yu Zizi, Parikh Anuraag, Chen Jenny X, Lin Derrick T, Emerick Kevin S, Faquin William C, Varvares Mark A, Deschler Daniel G
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Harvard Medical School, Boston, Massachusetts, USA.
ORL J Otorhinolaryngol Relat Spec. 2019;81(1):55-62. doi: 10.1159/000497438. Epub 2019 Apr 2.
BACKGROUND/AIMS: The importance of adjuvant radiotherapy in patients with close margin resections for mucoepidermoid carcinoma of the parotid gland remains unclear.
Patients who underwent parotidectomy for mucoepidermoid carcinoma with or without adjuvant radiotherapy at a single academic tertiary care center from 2000 to 2014 were identified. Included patients had negative but close (≤2 mm) surgical margins without other high-risk histopathological factors including advanced T-stage, positive nodal disease, lymphovascular or perineural invasion, or high-grade histology.
Nineteen patients were identified, of whom 15 (79%) were observed postoperatively, while 4 (21%) underwent adjuvant radiotherapy. There were no significant differences in extent of parotidectomy, elective neck dissection, T staging, or tumor size between patients who were observed and those undergoing adjuvant radiation. There were no locoregional or distant recurrences in any patients at a mean follow up 74.3 months. Patients undergoing adjuvant radiation, however, had significantly more intermediate-grade as compared to low-grade histology (75% vs. 13%, difference 62%, 95% CI 4% to 100%).
Patients with negative but close (≤2 mm) surgical margins without other high-risk histopathological factors have excellent long-term locoregional control with surgery alone. The effects of adjuvant radiotherapy for those who have intermediate-grade disease remain uncertain.
背景/目的：腮腺黏液表皮样癌手术切缘接近时辅助放疗的重要性仍不明确。
确定2000年至2014年在一家学术性三级医疗中心接受腮腺黏液表皮样癌手术切除且有或无辅助放疗的患者。纳入的患者手术切缘阴性但接近（≤2 mm），且无其他高危组织病理学因素，包括晚期T分期、阳性淋巴结病、淋巴管或神经周围侵犯或高级别组织学。
共确定19例患者，其中15例（79%）术后观察，4例（21%）接受辅助放疗。观察患者与接受辅助放疗患者在腮腺切除范围、选择性颈清扫、T分期或肿瘤大小方面无显著差异。平均随访74.3个月时，所有患者均无局部区域或远处复发。然而，与低级别组织学相比，接受辅助放疗的患者中级别组织学显著更多（75%对13%，差异62%，95%CI 4%至100%）。
手术切缘阴性但接近（≤2 mm）且无其他高危组织病理学因素的患者仅通过手术即可获得良好的长期局部区域控制。辅助放疗对中级别疾病患者的效果仍不确定。
