Practice Patterns in Management of Low- to Intermediate-Grade Salivary Gland Carcinoma: A Multi-Institutional Study

Mirabelle Sajisevi, Division of Otolaryngology University of Vermont Medical Center Burlington USA.
Kenny Nguyen, Robert Larner College of Medicine University of Vermont Burlington Vermont USA.
Peter Callas, Robert Larner College of Medicine University of Vermont Burlington Vermont USA.
Andrew J. Holcomb, Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital Omaha Nebraska USA.
Emre Vural, Department of Otolaryngology University of Arkansas for Medical Sciences Little Rock Arkansas USA.
Kyle P. Davis, Department of Otolaryngology St Louis University School of Medicine St Louis Missouri USA.
Carissa M. Thomas, Department of Otolaryngology University of Alabama at Birmingham Birmingham Alabama USA.
John S. Stein, Department of Otolaryngology University of Alabama at Birmingham Birmingham Alabama USA.
Ameya Asarkar, Department of Otolaryngology/Head & Neck Surgery Ochsner-LSU Health Shreveport Louisiana USA.
Ricardo Aulet, Department of Otolaryngology, UMass Memorial Medical Center Worcester Massachusetts USA.
Rebecca K. Bell, Geisel School of Medicine at Dartmouth, Section of Otolaryngology, Dartmouth Hitchcock Medical Center Lebanon New Hampshire USA.
Michael A. Blasco, Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell Northwell Health Cancer Institute New York New York USA.
Vanessa B. Bowmaster, University of Nebraska College of Medicine Omaha Nebraska USA.
Clayton P. Burruss, University of Kentucky, Department of Otolaryngology-Head and Neck Surgery Lexington Kentucky USA.
Jeffson Chung, Department of Otolaryngology - Head & Neck Surgery West Virginia University Morgantown West Virginia USA.
Kimberly Chan, Department of Otolaryngology Head and Neck Surgery Penn State College of Medicine Hershey Pennsylvania USA.
Brent A. Chang, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic Arizona Phoenix Arizona USA.
Charles S. Coffey, Department of Otolaryngology/Head and Neck Surgery UC San Diego School of Medicine San Diego California USA.
David M. Cognetti, Department of Otolaryngology - Head & Neck Surgery, Sidney Kimmel Medical College/Sidney Kimmel Cancer Center Thomas Jefferson University Philadelphia Pennsylvania USA.
Dylan J. Cooper, Department of Otolaryngology, Donald and Barbara Zucker School of Medicine/Northwell Northwell Health Cancer Institute New York New York USA.
Joehassin Cordero, Department of Otolaryngology and Head & Neck Surgery Texas Tech University - Health Sciences Center Lubbock Texas USA.
John Donovan, Salem Hospital Salem Oregon USA.
Yue Jennifer Du, Faculty of Medicine University of Toronto Toronto Canada.
Yusuf Dundar, Department of Otolaryngology and Head & Neck Surgery Texas Tech University - Health Sciences Center Lubbock Texas USA.
Rogerio Dedivitis, Department of Head and Neck Surgery University of São Paulo School of Medicine São Paulo Brazil.
Heather Edwards, Department of Otolaryngology Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA.
Boban M. Erovic, Institute of Head and Neck Diseases, Evangelical Hospital Vienna Vienna Austria.
Antoine Eskander, Department of Otolaryngology - Head and Neck Surgery University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital Toronto Canada.
Philip A. Feinberg, Medical Scientist Training Program UMass Chan Medical School Worcester Massachusetts USA.
Emily A. Garvey, Department of Otolaryngology - Head and Neck Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA.
David Goldstein, Department of Otolaryngology-Head & Neck Surgery University of Toronto Toronto Canada.
Joseph F. Goodman, Division of Otolaryngology-Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington DC USA.

Document Type

Journal Article

Publication Date

10-1-2025

Journal

Laryngoscope investigative otolaryngology

Volume

10

Issue

5

DOI

10.1002/lio2.70246

Keywords

facial nerve outcomes; guidelines; guidelines dissemination; major salivary gland cancer; practice patterns

Abstract

OBJECTIVES: To characterize practice patterns and outcomes in the management of low- and intermediate-grade salivary gland carcinoma prior to the existence of treatment guidelines. METHODS: Analysis of a registry of patients who underwent parotid and submandibular gland resections for low-and intermediate-grade carcinomas between 2010 and 2019. RESULTS: Of all 786 patients included in the study, 726 (92%) had preoperative imaging and 653 (83%) had preoperative biopsy. Of the 729 patients with parotid gland cancer, the majority underwent superficial (n = 384, 53%) or total (n = 254, 35%) parotidectomy. In patients with facial nerve preservation, total parotidectomy was associated with a significant increase in transient facial weakness (72/177 (41%) vs. 82/311 (26%), RR 0.65, 95% CI 0.50-0.84, p < 0.05) and permanent facial nerve weakness (23/176 (13%) vs. 16/301 (5%), RR 0.41, 95% CI 0.22-0.75, p < 0.05) compared to superficial parotidectomy. Adjuvant radiation therapy (RT) was delivered to 285 (36%) patients. The proportion of patients receiving adjuvant RT declined significantly over the time period from 2015 to 2019 compared to 2010 to 2014 at 162/504 (32%) and 123/282 (44%), respectively (RR 0.74, 95% CI 0.61-0.89, p < 0.05). When comparing the time periods from 2015 to 2019 and 2010 to 2014, there was no significant difference in local control rates (RR 0.52, 95% CI 0.26-1.04, p = 0.06) or regional control rates (RR 0.75, 95% CI 0.26-2.13, p = 0.58). CONCLUSIONS: Management of low- and intermediate-grade salivary cancer from 2010 to 2019 was variable, which is expected given the rarity and heterogeneity of the disease and the lack of treatment guidelines prior to 2021. Most patients with parotid malignancies underwent superficial or total parotidectomy. The extent of parotidectomy had an impact on facial nerve function outcomes. Delivery of adjuvant radiation trended down with time. The data presented here will support dissemination of the guidelines and provide data that could inform future trials. LEVEL OF EVIDENCE: 2b.

Department

Surgery

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