Management of cancer of the parotid gland

This review integrates current research on assessment, management options and respective outcomes, and prognostic considerations into the existing knowledge on parotid carcinoma. Standard management remains a complete resection, with sacrifice of facial nerve branches only for obvious neural invasion. Histologically and cytologically proven neck disease requires combined surgery and radiotherapy. Elective neck treatment is reserved for advanced stage, high-grade tumors. Postoperative radiotherapy, improving locoregional control, can be omitted only in low-stage, low-grade tumors with no additional negative prognostic factors. Improved locoregional control results in distant metastasis as the main evidence of treatment failure, for which systemic treatment today remains insufficient. Because of the complex combined influence of an amalgam of prognostic factors, current treatment results vary widely within the patient population. An increasingly quantitative approach to prognosis could help clinicians understand and compare these differences. One step to this more quantitative approach is a properly validated prognostic index summarizing the weighted contributions of each prognostic factor in one patient, improving prognostic accuracy.