Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;70(2):161-170.
doi: 10.1002/jmrs.650. Epub 2023 Feb 15.

Metastatic cutaneous squamous cell carcinoma to the parotid: Adjuvant radiotherapy and treatment outcomes

Marcus Hu  1   2 , Anna N H Kim  2 , Theophilus I Emeto  3   4 , Michael Collins  1 , Andrea Chopping  1 , Charles Lin  2   5
Affiliations

Metastatic cutaneous squamous cell carcinoma to the parotid: Adjuvant radiotherapy and treatment outcomes

Marcus Hu et al. J Med Radiat Sci. 2023 Jun.

Abstract

Introduction: Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy technique, dose and volumes are seldom described sufficiently to allow close examination. We report our treatment outcomes and focus on treatment-related factors that affect outcomes in this cohort.

Methods: We performed a retrospective review of patients with metastatic cutaneous SCCs who underwent parotidectomy with or without ipsilateral neck dissection. All patients received adjuvant radiotherapy. Demographics, clinical data and treatment details were collected from an intuitional electronic database. Individual patient-level radiotherapy technique, volumes and doses were reviewed.

Results: Between July 2008 and July 2018, 60 patients met our inclusion criteria. Median follow-up duration was 32.7 months. The mean age was 66.4 years. The majority of patients (49 patients) received full neck irradiation. The 2-year and 5-year loco-regional failure-free survival was 87% (95% confidence interval (CI): 0.74-0.93) and 71% (95% CI: 0.52, 0.83), respectively. The 2-year and 5-year overall survival was 76% (95% CI: 0.62, 0.85) and 60% (95% CI: 0.45, 0.72), respectively. There were 15 cases of loco-regional failures, with 6 cases with dermal involvement. Lymphovascular invasion (LVI) was associated with higher loco-regional failure (hazard ratio: 8.43, 95% CI: 1.85-38.39, P = 0.005) and cancer-specific mortality (hazard ratio: 5.40, 95% CI: 1.40-20.87, P = 0.015). Treatment technique, intensity-modulated radiation therapy (IMRT) vs 3D conformal radiotherapy (3D CRT), bolus use, perineural invasion (PNI) and surgical margins were not significantly associated with loco-regional failure.

Conclusion: We demonstrated high loco-regional control rates with routine use of comprehensive adjuvant radiotherapy. The presence of LVI was identified as a strong predictor for recurrence. Further analysis will help to define optimal radiation dose and techniques.

Keywords: adjuvant skin neoplasms retrospective studies carcinoma; radiotherapy; squamous cell parotid neoplasms.

PubMed Disclaimer

Conflict of interest statement

The authors of this paper have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(a) Digitally reconstructed radiograph (DRR) illustrating one beam treating parotid bed and upper neck nodes in a representative 3D‐CRT plan. (b) Digitally reconstructed radiographs (DRRs) illustrating one beam treating lower neck nodes below the junction in a representative 3D‐CRT plan.
Figure 2
Figure 2
(a) Treatment planning dose distribution of same patient as Figure 1, using wedged pair configuration. (b) Treatment planning dose distribution for a representative 5‐field step‐and‐shoot intensity modulated radiation therapy (IMRT).
Figure 3
Figure 3
(a) Kaplan–Meier graph showing loco‐regional control for entire treatment cohort. (b) Kaplan–Meier graph showing overall survival for entire treatment cohort. (c) Kaplan–Meier graph showing loco‐regional control for entire treatment cohort stratified by lymphovascular (LVI) status.
See this image and copyright information in PMC

References

    1. Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG. Non‐melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 2006; 184: 6–10. - PubMed
    1. Australian Institute of Health and Welfare . Skin cancer in Australia. AIHW, Canberra, 2016.
    1. Joseph MG, Zulueta WP, Kennedy PJ. Squamous cell carcinoma of the skin of the trunk and limbs: The incidence of metastases and their outcome. ANZ J Surg 1992; 62: 697–701. - PubMed
    1. O'Brien CJ, McNeil EB, McMahon JD, Pathak I, Lauer CS, Jackson MA. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck 2002; 24: 417–22. - PubMed
    1. Vauterin TJ, Veness MJ, Morgan GJ, Poulsen MG, O'Brien CJ. Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck. Head Neck 2006; 28: 785–91. - PubMed