Nodal recurrence in primary malignant epithelial tumours of the parotid gland

An analysis has been made of the incidence of nodal recurrence in 237 patients with primary carcinoma of the parotid gland. Fifty eight patients (24.4%) developed nodal metastases; mostly in the cervical region. Eighteen of these metastases were within the radiation field and 13 were outside the radiation field. Factors which were predictive for nodal relapse were: Age greater than 60 years, T3 and T4 tumours, node metastases at initial presentation, and macroscopic disease at either the primary site or the nodal site. The complete response rate for treatment of nodal relapse was 19% and the partial response rate was 17.2%. The 5 year actuarial survival from the time of first presentation was 58%. The pattern of nodal recurrence in this study indicates that radiation portals should cover more than the first eschalon (upper deep cervical) nodes. Our current policy is to recommend elective irradiation of the lower cervical nodes in patients with primary parotid malignancies.