Humans ; Practice Guidelines as Topic ; Salivary Gland Neoplasms ; diagnosis ; radiotherapy ; surgery ; Salivary Glands ; surgery

OBJECTIVETo dynamically analyze the change of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy by DW MRI.

METHODSTwenty-three nasopharyngeal carcinoma patients confirmed by pathology were enrolled. Male/Female: 19/4. The age was from 37 to 69 years. The patients were divided into two groups: G1, Dmean<26 Gy, G2, Dmean ≥ 26 Gy. All patients underwent salivary glands examination by DW MRI before IMRT, at the end of IMRT, 6 months and 12 months after IMRT, at the same time the ADC value of salivary glands were calculated. According to the RTOG/EORTC salivary gland injury grading standard and referring the subjective index, the degree of xerostomia was assessed. SPSS 13.0 and SAS 8.2 software were used to analyze the data.

RESULTSAt the end of IMRT, the change tendency of ADC in parotid and submandibular glands value was different in patients with different degree of xerostomia (F = 11.52, P < 0.01). At the end of IMRT, a significant difference for degree of xerostomia could be found in patients within different irradiation dose groups (Z = -3.622, P < 0.01). Clinical stage, treatment mode and age had no significant effect on the degree of xerostomia for patients at the end of IMRT (Z value was -0.791, -0.949, 2.488, all P > 0.05). A significant difference of xerostomia degree in patients was found at the various follow-up time after IMRT (χ(2) = 19.59, P < 0.01).

CONCLUSIONSThere is good correlation between the function of salivary gland and subjective rating of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy. The degrees of salivary gland function and dry mouth in patients with nasopharyngeal carcinoma damage evaluate with illuminated dose increases. The function of salivary gland gradually restored and the degree of dry mouth gradually reduce with the extension of time after radiotherapy.

Carcinoma ; Humans ; Nasopharyngeal Neoplasms ; complications ; radiotherapy ; Parotid Gland ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Salivary Glands ; Submandibular Gland ; Xerostomia ; etiology

OBJECTIVE: To investigate the clinical application and efficacy of ¹²⁵Ⅰ radioactive seeds implantation in the treatment of recurrent salivary gland carcinoma after external radiotherapy. METHODS: From July 2004 to July 2016, 43 cases of recurrent salivary gland carcinoma of the neck after external radiotherapy or surgery combined with external radiotherapy were treated. According to the conventional segmentation radiotherapy for head and neck cancer (once a day, 1.8-2.0 Gy each time, 5 days per week), the cumulative radiation dose of the patients in this group was calculated. In the study, 26 patients received 50-60 Gy, 7 patients received less than 50 Gy, 4 patients received 60-70 Gy, and 6 patients received more than 80 Gy (range: 80-120 Gy). The interval between the last external irradiation and local recurrence was 4-204 months, and the median interval was 48 months. Among them, 25 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation only and 18 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation after operation. The prescription dose was 100-140 Gy. The control rate, survival rate and disease-free survival rate were recorded to evaluate the side effects. RESULTS: The median follow-up time was 27 months (ranging from 2.5 to 149.0 months). Among them, the median follow-up time of adenoid cystic carcinoma patients was 31 months (range: 2.5-112.0 months), and the median follow-up time of mucoepidermoid carcinoma patients was 18 months (range: 5-149 months). The local control rates for 1, 3 and 5 years were 66.5%, 48.8% and 42.7%, respectively. The 1-, 3- and 5- year survival rates were 88.0%, 56.7% and 45.8%, respectively. The disease-free survival rates of 1, 3 and 5 years were 58.3%, 45.4% and 38.1%, respectively. There was no statistically significant difference in local control rate, survival rate, and disease-free survival between the radioactive seeds implantation group and the radioactive seeds implantation group after surgical resection. There were 2 cases of acute radiation reaction Ⅰ/Ⅱ and 3 cases of reaction Ⅲ or above. In the late stage of radiotherapy, there were 8 cases with Ⅰ/Ⅱ grade reaction and 3 cases with Ⅲ grade or above reaction. The incidence of radiation reactions of Grade Ⅲ and above was 7%. CONCLUSION ¹²⁵Ⅰ radioactive seeds implantation provides an alternative method for the treatment of recurrent salivary gland carcinoma after external radiotherapy. The local control rate and survival rate are improved on the premise of low incidence of side effects.
Brachytherapy/adverse effects* ; Humans ; Iodine Radioisotopes/therapeutic use* ; Neoplasm Recurrence, Local/radiotherapy* ; Salivary Gland Neoplasms/radiotherapy* ; Salivary Glands

Sebaceous carcinoma of the salivary gland is an extremely unordinary malignancy occurring mainly in the parotid gland. Sebaceous carcinoma arising in the submandibular gland is exceptional and only three cases have been reported in the literature. We herein present a unique case of sebaceous carcinoma of the submandibular gland, the first to be reported in literature in South Korea. An 85-year-old man visited our hospital complaining of a progressively enlarging submandibular mass with tenderness and ipsilateral facial palsy. We performed a wide excision of the mass with superficial parotidectomy and modified neck dissection. Microscopic and immunohistochemical examinations demonstrated sebaceous carcinoma of low grade differentiation. Further adjuvant radiotherapy was rejected and the patient was followed up for five months. The optimal treatment of sebaceous carcinoma of the salivary gland is still not established due to the rarity of the disease. When more cases are reported, the clinicopathologic characteristics will be better understood.
Aged, 80 and over ; Facial Paralysis ; Humans ; Korea ; Neck Dissection ; Parotid Gland ; Radiotherapy, Adjuvant ; Salivary Gland Neoplasms ; Salivary Glands ; Submandibular Gland Neoplasms ; Submandibular Gland*

PURPOSE: This study aimed to evaluate the long-term survival outcomes and prognostic factors that affect the clinical outcomes of patients who underwent surgery and postoperative radiotherapy for major salivary gland mucoepidermoid carcinoma (MEC). MATERIALS AND METHODS: We retrospectively reviewed the clinical data of 44 patients who underwent surgery followed by radiotherapy for primary MEC of the major salivary glands between 1991 and 2014. The median follow-up period was 9.8 years (range, 0.8 to 23.8 years). RESULTS: The overall outcomes at 5 and 10 years were 81.5% and 78.0% for overall survival (OS), 86.2% and 83.4% for disease-free survival, 90.6% and 87.6% for locoregional recurrence-free survival, and both 90.5% for distant metastasis-free survival (DMFS). Histologic grade was the only independent predictor of OS (low vs. intermediate vs. high; hazard ratio = 3.699; p = 0.041) in multivariate analysis. A poorer survival was observed among patients with high-grade tumors compared with those with non-high-grade tumors (5-year OS, 37.5% vs. 91.7%, p < 0.001; 5-year DMFS, 46.9% vs. 100%, p < 0.001). CONCLUSION: Surgery and postoperative radiotherapy resulted in excellent survival outcomes for patients with major salivary gland MEC. However, high-grade tumors contributed to poor DMFS and OS. Additional aggressive strategies for improving survival outcomes should be developed for high-grade MEC.
Carcinoma, Mucoepidermoid ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Radiotherapy ; Retrospective Studies ; Salivary Gland Neoplasms ; Salivary Glands

Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.
Adult ; Carcinoma, Acinar Cell* ; Echocardiography ; Electrons ; Humans ; Joints ; Neoplasm Metastasis* ; Parotid Gland* ; Parotid Neoplasms ; Radiotherapy ; Salivary Glands

OBJECTIVE: To investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia. MATERIALS AND METHODS: This study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia. RESULTS: The ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10−3 mm2/s and 1.32 ± 0.07 × 10−3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10−3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10−3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10−3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10−3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT. CONCLUSION: The ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.
Diffusion ; Follow-Up Studies* ; Head and Neck Neoplasms ; Humans ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Odds Ratio ; Parotid Gland ; Radiotherapy ; Salivary Glands* ; Submandibular Gland ; Xerostomia*

OBJECTIVETo evaluate the dynamic change of salivary gland function in patients with nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT) by DWMRI.

METHODSTwenty-three NPC patients confirmed by pathology were enrolled. Male/Female: 19/4. The age was from 37 to 69 years. All cases underwent salivary glands examination by DWMRI before IMRT, at the end of IMRT, 6 months and 12 months after IMRT, at the same time the ADC value of salivary glands were calculated. The patients were divided into two groups: G1, Dmean < 26 Gy, G2, Dmean ≥ 26 Gy. SPSS 13.0 and SAS 8.2 software was used to analyze the date.

RESULTSThe ADC values of parotid in two group patients at rest were not significantly different between 6 months after and at the end of IMRT (t value was 0.732, 1.405, all P > 0.05). The ADC values of parotid in two group patients at rest were significantly lower in the 12 months after IMRT than at the end of IMRT (t value 2.621, 3.417, all P < 0.05). During the period of acid stimulation, A significant change of ADC in parotid was found in G1 (all P < 0.05) and no significant change of ADC in parotid was found in G2 at the various follow-up time after IMRT (all P > 0.05). At the various follow-up time after IMRT, the average ADC values of parotid were significantly higher in G2 than G1 in the same time points of acid stimulation (all P < 0.05). The ADC values of submandibular glands at rest were significantly higher at the various follow-up time after IMRT than before IMRT (t value was -9.782, -8.963, -7.722, all P < 0.05). During the period of acid stimulation no significant change of ADC in submandibular glands was found after IMRT (F = 1.124, P = -0.348).

CONCLUSIONSThe changes of salivary function can be well reflected by ADC values. There is a good clinical application value of DWMRI for evaluating radiation-induced salivary glands functional changes and observing salivary function recovery during the follow-up period after IMRT.

Adult ; Aged ; Carcinoma ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Parotid Gland ; radiation effects ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Recovery of Function ; Salivary Glands ; radiation effects ; Submandibular Gland ; radiation effects

Malignant salivary gland tumors only represent 0.08% of all childhood tumors and mucoepidermoid carcinoma (MEC) is the most common histologic type. Although there are many reports describing second malignant neoplasm (SMN) in patients treated for childhood cancer, salivary gland tumors rarely appears. In Korea, there has been no report about MEC that developed in children as a SMN. We report a MEC in a 4 years and 8 months old female child that developed after completing treatment for yolk sac tumor of lower abdomen. The primary tumor presented with metastasis at the time of diagnosis, and therefore, the child underwent high-dose chemotherapy with autologous peripheral blood stem cell transplantation along with surgery and radiotherapy. Three years and five months after completing treatment, MEC developed in her submandibular gland. She was treated with surgery and radiotherapy and is in disease free state for 5 months at the time of this writing.
Abdomen ; Carcinoma, Mucoepidermoid ; Child ; Diagnosis ; Drug Therapy ; Endodermal Sinus Tumor ; Female ; Humans ; Korea ; Neoplasm Metastasis ; Peripheral Blood Stem Cell Transplantation ; Radiotherapy ; Salivary Gland Neoplasms ; Salivary Glands ; Submandibular Gland ; Writing

BACKGROUND: Functional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. METHODS: Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy. RESULTS: Among the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy. CONCLUSIONS: The results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.
Facial Expression ; Facial Nerve* ; Follow-Up Studies ; Head ; Humans ; Neck ; Neurilemmoma ; Quality of Life ; Radiotherapy ; Salivary Gland Neoplasms ; Sural Nerve* ; Survival Rate ; Transplants*