[Exclusive radiotherapy of parotid metastases. Results in 14 cases]

Parotid metastases are uncommon lesions. In most cases the skin of the head and neck is the site of the primary tumor, which is usually a squamous cell carcinoma or a melanoma. Infraclavicular or non-cutaneous head and neck cancers one less likely to cause a parotid metastasis. From 1968 to 1991, 38 patients (9 men and 5 women aged 45 to 96 years) affected with parotid metastases, were treated in the Department of Radiotherapy at the Ospedale Maggiore of Novara. All patients received exclusive irradiation. In 12 patients the primary lesion was found in the skin of the head and neck (11 squamous cell carcinomas and 2 melanomas), one had an undifferentiated nasopharyngeal carcinoma and one a squamous cell lung carcinoma. In 9 cases the parotid gland was the only site of metastasis, in 2 cases lateral cervical lymph nodes metastases were also present and in 3 cases distant metastases. Radiotherapy was performed with cobalt 60; the target volume was limited to the parotid region in the N1-N2a cases and included the ipsilateral cervical nodes in the N2b-N3a cases. The doses ranged 24-66 Gy (mean: 50, median-52), with daily fractionation of 1.8-2 Gy for 5 days/week. After radiotherapy local control was obtained in 8/14 cases (57%), maintained at 2 years in 7/14 patients and at 5 years in 2/10 patients (20%). Eight patients (57%) relapsed in the parotid and/or cervical areas and/or exhibited widespread metastases and finally died; 6 patients (43%) were NED after a minimum 3 years' follow-up. Parotid metastases are usually treated by surgical resection; radiotherapy can be used as postoperative or exclusive treatment. Exclusive radiotherapy can be used for the skin cancers which are inoperable for general or local conditions (fixation, necrosis, ulceration), for mucosal head and neck cancers treated by radiotherapy and for infraclavicular tumors as a palliative treatment. Prognosis is different for skin cancer, mucosal and head and neck a carcinoma and infraclavicular neoplasms. The best results can be obtained with N1 nodes and high-dose irradiation.