Vol 26, No 6 (2021)
Research paper
Published online: 2021-11-08

open access

Page views 5888
Article views/downloads 346
Get Citation

Connect on Social Media

Connect on Social Media

Adjuvant radiotherapy in malignant tumors of parotid. Experience of the Navarra Hospital Complex

Maitane Rodríguez-Mendizábal1, Sonia Flamarique Andueza1, Isabel Quílez Sarda2, Maider Campo1, Gemma Asín Felipe1, Lombardo Rosas Gutierrez1, Andrea Barco Gomez, Fernando Arias de la Vega2
Rep Pract Oncol Radiother 2021;26(6):962-967.


Background: The objective of the study was to review the outcome of patients with parotid cancer treated with postoperative radiotherapy at Complejo Hospitalario de Navarra in the last ten years.

Materials and methods: We retrospectively reviewed patients treated with adjuvant radiotherapy between January 2008 and December 2018. We analyzed demographic data, histopathologic findings,  local control (LC) and overall survival (OS).

Results: A total of 40 patients received postoperative radiotherapy during the period mentioned. There were 22 men (55%) and 18 women (45%). Median age was 58 years (19–90). By tumor histology, the most common was squamous cell carcinoma (22.5%) followed by ex-pleomorphic adenoma (15%) and adenoid cystic carcinoma (10%). According to Surgery, 19 patients (47.5%) underwent a total parotidectomy, 20 (50%) partial parotidectomy, and 1 (2.5%) a radical parotidectomy. Twenty-one patients (51.2%) underwent cervical dissection, most of them being supraomohyoid (31.7%). Reasons for adjuvant RT were: R1 resection (35% of the patients), high grade tumors (27.5%) and 17.5% because R1 surgery and R1. Radiation was administered using IMRT in most patients to a total dose of 60 Gy in 30 fractions. The 5-year overall survival (OS) (Kaplan-Meier) was 81% (95% CI: 68.5–96.2%), and 10-years — 64%.

The 5-year local control (LC) (Kaplan-Meier) was 82.4% (95% CI: 91.46–73.33%) and the 10-year LC — 72.2% (95% CI: 54.9–96%).  

To date, only 4 patients (10%) have died due to their parotid tumor.

Conclusion: The adjuvant radiotherapy added to surgery, significantly reduces the risk of recurrence in high-risk patients with a very acceptable survival rate.

Article available in PDF format

View PDF Download PDF file


  1. Gupta A, Koochakzadeh S, Neskey DM, et al. Incidence and survival trends of parotid malignancies over 42 years. Head Neck. 2020; 42(9): 2308–2315.
  2. Seethala RR, Stenman G. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland. Head Neck Pathol. 2017; 11(1): 55–67.
  3. Mahmood U, Koshy M, Goloubeva O, et al. Adjuvant radiation therapy for high-grade and/or locally advanced major salivary gland tumors. Arch Otolaryngol Head Neck Surg. 2011; 137(10): 1025–1030.
  4. Terhaard CHJ, Lubsen H, Rasch CRN, et al. Dutch Head and Neck Oncology Cooperative Group. The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys. 2005; 61(1): 103–111.
  5. Armstrong JG, Harrison LB, Spiro RH, et al. Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg. 1990; 116(3): 290–293.
  6. Garden AS, el-Naggar AK, Morrison WH, et al. Postoperative radiotherapy for malignant tumors of the parotid gland. Int J Radiat Oncol Biol Phys. 1997; 37(1): 79–85.
  7. North CA, Lee DJ, Piantadosi S, et al. Carcinoma of the major salivary glands treated by surgery or surgery plus postoperative radiotherapy. Int J Radiat Oncol Biol Phys. 1990; 18(6): 1319–1326.
  8. Parsons JT, Mendenhall WM, Stringer SP, et al. Management of minor salivary gland carcinomas. Int J Radiat Oncol Biol Phys. 1996; 35(3): 443–454.
  9. Dunn EJ, Kent T, Hines J, et al. Parotid neoplasms: a report of 250 cases and review of the literature. Ann Surg. 1976; 184(4): 500–506.
  10. Shah K, Javed F, Alcock C, et al. Parotid cancer treatment with surgery followed by radiotherapy in Oxford over 15 years. Ann R Coll Surg Engl. 2011; 93(3): 218–222.
  11. Borthne A, Kjellevold K, Kaalhus O, et al. Salivary gland malignant neoplasms: treatment and prognosis. Int J Radiat Oncol Biol Phys. 1986; 12(5): 747–754.
  12. Kim YH, Chung WK, Jeong JU, et al. Evaluation of Prognostic Factors for the Parotid Cancer Treated With Surgery and Postoperative Radiotherapy. Clin Exp Otorhinolaryngol. 2020; 13(1): 69–76.
  13. Franzen A, Buchali A, Lieder A. The rising incidence of parotid metastases: our experience from four decades of parotid gland surgery. Acta Otorhinolaryngol Ital. 2017; 37(4): 264–269.
  14. Kirkbride P, Liu FF, O'Sullivan B, et al. Outcome of curative management of malignant tumours of the parotid gland. J Otolaryngol. 2001; 30(5): 271–279.
  15. Peters LJ, Withers HR. Applying radiobiological principles to combined modality treatment of head and neck cancer--the time factor. Int J Radiat Oncol Biol Phys. 1997; 39(4): 831–836.
  16. Wang X, Eisbruch A. IMRT for head and neck cancer: reducing xerostomia and dysphagia. J Radiat Res. 2016; 57 Suppl 1: i69–i75.
  17. Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011; 84(1007): 967–996.
  18. Hunter KU, Fernandes LL, Vineberg KA, et al. Parotid glands dose-effect relationships based on their actually delivered doses: implications for adaptive replanning in radiation therapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2013; 87(4): 676–682.

Reports of Practical Oncology and Radiotherapy