Management of high grade parotid carcinomas

Thirty-four patients admitted to the Bristol Royal Infirmary during the 20-year period 1966-85 and diagnosed as suffering from high grade parotid carcinoma were studied. The male:female ratio was 2.4:1, with a mean age at presentation of 68 years. Facial swelling was present in all patients with a mean duration of 9.9 months before treatment. Pain, deep fixation, facial nerve involvement, ulceration and distal metastases were all associated with a poor prognosis. Diagnosis was made either at operation or by fine needle biopsy. All 34 patients received radiotherapy. Fourteen patients (41 per cent) underwent a definitive surgical procedure. The local recurrence rates for the non-surgical and surgically treated groups were 30 per cent (six patients) and 36 per cent (five patients) respectively; twelve patients (60 per cent) in the non-surgical group developed distant metastases as opposed to six patients (43 per cent) in the surgical group. Both local and distant recurrent disease are indicators of poor prognosis, with only one patient alive at 104 months. Seven patients (21 per cent) remain recurrence free. Definitive surgery, combined with radiotherapy, improved survival in those with amenable localized disease.