MANAGEMENT OF THE NECK IN PAROTID CARCINOMA

BACKGROUND: Management of the clinically negative neck remains a contr oversial issue in patients with carcinoma of the parotid gland. Our tr eatment policy has always been conservative, reserving lymphadenectomy for selected patients. METHODS: We retrospectively evaluated 121 pati ents with malignant tumors of the parotid gland who received their def initive treatment at the Memorial Sloan-Kettering Cancer Center betwee n 1966 and 1988. RESULTS: A total of 35 neck dissections (ND) were per formed, 14 of which involved removal of clinically positive nodes (rad ical in 10, modified in 2, and limited in 3). Twenty-one patients had an elective lymphadenectomy (radical in 14, modified in 2, and limited in 4), usually because of ominous histology or high T stage. In addit ion to histologically positive regional lymph nodes, facial nerve para lysis, gender, and advanced stage, the decision to perform a ND, wheth er elective or therapeutic, was significantly predictive of decreased survival (P <0.001). In the majority of patients (86, or 65%), the nec k was observed rather than treated electively, with no impact on overa ll survival. Only 4 of 121 patients developed neck recurrence followin g treatment, including 3 who had neck dissection as part of their init ial management. CONCLUSIONS: These data support our policy of reservin g elective ND only for those histologic diagnoses that carry the highe st risk of nodal metastases, as well as for selected patients whose pr imary tumor resection might be facilitated by lymphadenectomy. (C) 199 6 by Excerpta Medica, Inc.