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Published on: October 13, 2023
Pediatric salivary gland carcinomas: Diagnostic and therapeutic management
Céleste Rebours1, Vincent Couloigner1, Louise Galmiche2
1Pediatric Ear, Nose, and Throat Department, Necker Hospital for Sick Children, Public Assistance-Hospitals of Paris, Paris, France.
Insights
Pediatric salivary gland carcinomas, though rare, show a good prognosis with surgery as the primary treatment. Recurrences can occur, but outcomes are generally favorable for children and adolescents.
Area of Science:
- Pediatric Oncology
- Head and Neck Surgery
- Rare Cancers
Background:
- Salivary gland carcinomas in children are rare, necessitating analysis of clinical data to improve care.
- Standardizing treatment protocols is crucial for managing these uncommon pediatric malignancies.
Purpose of the Study:
- To analyze clinical presentations, treatment strategies, and outcomes of pediatric salivary gland carcinomas.
- To establish standardized care guidelines for rare pediatric salivary gland tumors.
Main Methods:
- A multicentric, retrospective study involving children and adolescents (≤18 years) treated between 1992 and 2012.
- Review of pathological tumor specimens and clinical data from six pediatric centers in Paris, France.
Main Results:
- Forty-three pediatric patients were included, with the parotid gland being the most frequent tumor site.
- Mucoepidermoid and acinic cell carcinomas were the most common subtypes; surgery achieved complete resection in 80% of cases.
- Despite a 5-year median follow-up, six recurrences were noted, but no deaths occurred, indicating a favorable prognosis.
Conclusions:
- Childhood salivary gland carcinomas generally have a good prognosis, even with recurrences.
- Surgery is the cornerstone of treatment, often combined with lymph node dissection for enlarged nodes.
- Adjuvant radiation or chemotherapy is reserved for specific cases, such as inoperable tumors or post-recurrence management.
Objectives/Hypothesis:
To analyze clinical presentations, treatment modalities, and evolution of pediatric cases of salivary gland carcinomas to standardize care for these rare diseases.
Study Design:
Multicentric, retrospective study.
Methods:
We included in this retrospective study all children and adolescents (aged ≤18 years) treated from 1992 to 2012 in six pediatric centers in Paris, France. Pathological tumor specimens of these cases were reviewed.
Results:
Forty-three children were included (sex ratio male/female = 19/24, median age = 13 years). The parotid gland was the most common (37 cases) location for tumors. Histological subtypes were mucoepidermoid carcinomas (n = 20), acinic cell carcinomas (n = 14), and other (n = 9). Initial fine-needle aspiration was performed in 15 cases (33%), and was concordant to final diagnosis in three cases (20%). Primary surgery was performed in 42 patients, leading to a complete microscopic resection in 80%. Associated lymph node dissection was performed in 28 patients (homolateral: 27, bilateral: 1) and showed lymph node metastases in only two patients. One patient had distant metastases. Adjuvant irradiation was delivered to 11 patients (median: 60 Gy; range: 50-65) and chemotherapy in five cases. After a median follow-up of 5 years, six tumors relapsed, but no deaths occurred.
Conclusions:
Childhood salivary gland carcinomas have a good prognosis despite possible recurrences. Treatment is mainly based on surgery, with simultaneous node dissection in cases of clinical or radiologic node enlargement. Radiation therapy seems to be restricted to inoperable high-grade tumors or after recurrence.
Level Of Evidence:
4 Laryngoscope, 127:140-147, 2017.
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