MALIGNANT EPITHELIAL PAROTID TUMORS - A RATIONAL TREATMENT POLICY

Formal parotidectomy was undertaken in 271 patients by one surgeon ove r 11 years. Forty patients were treated for malignant salivary tumours (nine were recurrent). Low-grade tumours (45 per cent) were treated b y surgery alone, untreated high-grade tumours (55 per cent) by surgery and radiotherapy, before or after operation, depending on clinical fi ndings. The aims of surgery were to obtain tumour clearance, to preser ve the facial nerve if possible, and to perform radical neck dissectio n for palpable malignant lymphadenopathy proven cytologically and for high-grade tumours when intraoperative jugulodigastric lymph node biop sy confirmed metastasis. Four patients sustained facial weakness as a result of surgery. At a median of 46 months follow-up two patients had developed local recurrence. Eleven patients with high-grade but none with low-grade tumours died from metastases. Patients with high-grade lesions with facial weakness from malignant infiltration and those wit h lymphatic metastasis have a significantly worse prognosis than those without. Locoregional control of parotid cancers can be achieved by f ormal parotidectomy and selective irradiation without routine sacrific e of the facial nerve.