Abstract
Objectives
The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents.
Methods
Fifty‐three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan–Meier method. Log‐rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence.
Results
Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high‐risk factors received radiotherapy or chemotherapy. The median follow‐up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5‐year overall survival (OS) and 5‐year locoregional recurrence‐free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5‐year OS and 5‐year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log‐rank univariate test showed that tumor size >3.5 cm (p = .056), distant metastasis (p = .056), and stage III and IV (p = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS.
Conclusion
Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high‐grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment.
Level of evidence
Level 2.
Keywords: adolescents, children, parotid tumors, prognosis, treatment
We summarized and analyzed the demographic characteristics, clinical features, treatment modalities, and prognosis of parotid gland tumors in children and adolescents. Our study will provide more basis for the diagnosis and treatment of such tumors.
1. INTRODUCTION
Salivary gland tumors in children and adolescents are relatively rare, with an annual incidence of 0.8 per million, accounting for only 0.5% of all pediatric tumors. 1 Most salivary gland tumors occur in the parotid gland, accounting for approximately 63.2% of salivary gland tumors. In children and adolescents, pleomorphic adenoma and mucoepidermoid carcinoma are the most common types of benign and malignant parotid tumors, respectively. 2 Due to the low incidence of pediatric parotid tumors and the lack of large case reports, there are currently no clear guidelines for treatment, and there is also no consensus reported in the literatures, especially for lymph node dissection and radiotherapy. Clinicians usually learn from the treatment experience of adults, but the treatment may differ between the two. 3 To better understand the clinical features, treatment, and prognosis of this rare tumor, we conducted this study to provide a more specific reference for the diagnosis and treatment of pediatric parotid tumors.
2. MATERIALS AND METHODS
This retrospective study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Sichuan Cancer Hospital (SCCHEC‐03‐2021‐02). We included 53 children and adolescents with solid tumors of the parotid gland who were treated at Sichuan Cancer Hospital from January 2006 to November 2021. The inclusion criteria of this study were as follows: (1) age ≤19 years; (2) pathologically confirmed parotid solid tumor; and (3) treated in our hospital.
SPSS version 26.0 (SPSS, Inc., Chicago, IL) was used for analysis. For quantitative variables, the mean was calculated if the distribution was normal, otherwise, the median was calculated. Qualitative variables were expressed as numbers and percentages. Survival curves were estimated using the Kaplan–Meier method, and the log‐rank method was used to assess the effect of different variables on patient survival. In univariate analysis, variables with p < 0.1 were further subjected to multivariate Cox regression analysis, and a p < .05 was considered statistically significant.
3. RESULTS
3.1. Patient characteristics
Fifty‐three patients were included in our study, with 23 cases of malignant tumors (43.4%) and 30 cases of benign tumors (56.6%). As shown in Table 1 and Table 2, the number of male and female patients with both benign and malignant tumors was almost equal, and most patients were aged 10 years or older. The most common complaint was painless swelling of the parotid region, with 6 (20.0%) and 7 (30.4%) patients with benign and malignant tumors having pain in the parotid region at the first visit, respectively.
TABLE 1.
Clinical data of children and adolescents with benign parotid tumors.
| n = 30 | Percent (%) | |
|---|---|---|
| Age (years) | ||
| <10 | 1 | 3.3 |
| ≥10 | 29 | 96.7 |
| Gender | ||
| Male | 15 | 50.0 |
| Female | 15 | 50.0 |
| Pain a | ||
| Yes | 6 | 20.0 |
| No | 24 | 80.0 |
| Surgery | ||
| Local tumor excision | 2 | 6.7 |
| Partial parotidectomy | 24 | 80.0 |
| Total parotidectomy | 4 | 13.3 |
Pain in the parotid gland area before surgery.
TABLE 2.
Clinical data of children and adolescents with parotid malignancies.
| Pathological type, n (%) | ||||
|---|---|---|---|---|
| MEC | ACC | Other | All | |
| Age (years) | ||||
| <10 | 1 (11.1) | 2 (40.0) | 1 (11.1) | 4 (17.4) |
| ≥10 | 8 (88.9) | 3 (60.0) | 8 (88.9) | 19 (82.6) |
| Gender | ||||
| Male | 3 (33.3) | 2 (40.0) | 6 (66.7) | 11 (47.8) |
| Female | 6 (66.7) | 3 (60.0) | 3 (33.3) | 12 (52.2) |
| Pain a | ||||
| Yes | 4 (44.4) | 1 (20.0) | 2 (22.2) | 7 (30.4) |
| No | 5 (55.6) | 4 (80.0) | 5 (55.6) | 14 (60.9) |
| Unknown | 0 (0) | 0 | 2 (22.2) | 2 (8.7) |
| T stage | ||||
| T1 | 5 (55.6) | 2 (40.0) | 4 (44.4) | 11 (47.8) |
| T2 | 3 (33.3) | 2 (40.0) | 2 (22.2) | 7 (30.4) |
| T3 | 0 (0) | 1 (20.0) | 1 (11.1) | 2 (8.7) |
| T4 | 0 (0) | 0 (0) | 1 (11.1) | 1 (4.3) |
| Tx | 1 (11.1) | 0 (0) | 1 (11.1) | 2 (8.7) |
| N stage | ||||
| N0 | 7 (77.8) | 3 (60.0) | 5 (55.6) | 15 (65.2) |
| N1–3 | 0 (0) | 0 (0) | 2 (22.2) | 2 (8.7) |
| Nx | 2 (22.2) | 2 (40.0) | 2 (22.2) | 6 (26.1) |
| M stage | ||||
| M0 | 8 (88.9) | 5 (100.0) | 8 (88.9) | 21 (91.3) |
| M1 | 1 (11.1) | 0 (0) | 1 (11.1) | 2 (8.7) |
| Grading | ||||
| Low–intermediate | 9 (100.0) | 5 (100.0) | 5 (55.6) | 19 (82.6) |
| High | 0 (0) | 0 (0) | 3 (33.3) | 3 (13.0) |
| Unknown | 0 (0) | 0 (0) | 1 (11.1) | 1 (4.3) |
| Treatment | ||||
| S alone | 5 (55.6) | 4 (80.0) | 1 (11.1) | 10 (43.5) |
| S + R | 3 (33.3) | 0 (0) | 2 (22.2) | 5 (21.7) |
| S + C | 0 (0) | 0 (0) | 1 (11.1) | 1 (4.3) |
| S + R + C | 0 (0) | 0 (0) | 3 (33.3) | 3 (13.0) |
| Unknown a | 1 (11.1) | 1 (20.0) | 2 (22.2) | 4 (17.4) |
| Surgery | ||||
| Local tumor excision | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Partial parotidectomy | 3 (33.3) | 1 (20.0) | 3 (33.3) | 7 (30.4) |
| Total parotidectomy | 6 (66.7) | 4 (80.0) | 5 (55.6) | 15 (65.2) |
| Unknown | 0 (0) | 0 (0) | 1 (11.1) | 1 (4.3) |
| Lymph node dissection | ||||
| No | 4 (44.4) | 3 (60.0) | 5 (55.6) | 12 (52.2) |
| Yes | 5 (55.6) | 2 (40.0) | 4 (44.4) | 11 (47.8) |
Abbreviations: ACC, acinic cell carcinoma; C, chemotherapy; MEC, mucoepidermoid carcinoma; R, radiotherapy; S, surgery.
Unknown: because some patients were lost to follow‐up, it is uncertain whether the patients received further radiotherapy and chemotherapy after surgery.
As shown in Figure 1, the most common pathological type of benign tumor was pleomorphic adenoma (29/30, 96.7%). Mucoepidermoid carcinoma (9/23, 39.1%) was the most common malignant tumor, followed by acinic cell carcinoma (5/23, 21.7%) and adenocarcinoma (3/23, 13.0%). Most were T1 or T2 (78.2%) and low or intermediate grade (82.6%); lymph node metastasis (8.7%) or distant metastasis (8.7%) were less common (Table 2). Of these, 9 patients were referred to our hospital for further treatment after pathological confirmation of malignancy, and 7 patients received only radiotherapy or chemotherapy at our hospital after surgery at other hospitals.
FIGURE 1.
Distribution of benign and malignant tumors (n = 53). The proportion of each type of pathology is expressed as a percentage and the number is given in brackets. NOS, not otherwise specified.
3.2. Treatment
Of the 23 patients with malignant tumors in this study, all underwent surgery (Table 2), with total parotidectomy (65.2%) being the most common procedure. Eight patients (34.8%) received postoperative radiotherapy. The radiotherapy dose ranged from 50 to 66 Gy (median dose 60 Gy), and 1 case was combined with cervical lymph node irradiation. Four cases (17.4%) received chemotherapy. The choice of chemotherapy drug was mainly determined by the pathological type. The drugs used for mucoepidermoid carcinoma were paclitaxel + cisplatin; the CVADIC regimen was used for sarcomas, that is, cyclophosphamide + vincristine + doxorubicin epirubicin/epirubicin + dacarbazine.
3.3. Complications
Facial palsy was observed in 17 patients, including 9 patients with temporary facial palsy (Table 3), 6 patients with permanent facial palsy, and 2 patients who were lost to follow‐up and could not be evaluated. Twelve patients developed Frey syndrome, with facial flushing and sweating when eating. After radiotherapy, 2 patients developed pigmentation around the parotid region, and 1 patient developed deformation of the auricle. The remaining patients had no obvious maxillofacial deformity or skin fibrosis in the parotid region after radiotherapy.
TABLE 3.
Complications of benign and malignant parotid tumors in children and adolescents.
| Malignant tumor (n) | Benign tumor (n) | All (n) | |
|---|---|---|---|
| Facial nerve resection | 1 | 1 | 2 |
| Facial palsy | |||
| Temporary | 3 | 6 | 9 |
| Permanent | 4 | 2 | 6 |
| Frey syndrome | 6 | 6 | 12 |
3.4. Follow‐up
Telephone follow‐up was performed until July 1, 2022. Forty‐three patients were followed up, the follow‐up rate was 81.1% and the median follow‐up time was 61 months (4–261 months).
Among them, 1 patient with pleomorphic adenoma underwent total parotidectomy in our hospital after two operations in other hospitals. She underwent another operation at our hospital 9 years later and has had no recurrence for 5.5 years. The remaining patients with benign tumors had no recurrence after surgery in our hospital. Five patients with malignant tumors (Table 4) had local recurrence or distant metastasis. The median duration of recurrence was 29 months (range, 10–72 months). Four patients with recurrence underwent total parotidectomy, 2 of whom also received postoperative chemotherapy and radiotherapy. In addition, 2 patients metastasized to the lumbar spine (mucoepidermoid carcinoma, T2NxM1, stage IVC, intermediate grade) and brain (sarcoma, TxN1M1, stage IVC, high grade). Two patients died from brain metastasis and other reason.
TABLE 4.
Treatment for five patients with recurrence of parotid malignancies.
| Tumor characteristics | Initial treatment | Recurrence time (months) | Site of recurrence | Treatment after relapse | Follow‐up time (months) | ||||
|---|---|---|---|---|---|---|---|---|---|
| S | R | C | S | R | C | ||||
| MEC (T2N0M0) | √ | × | × | 10 | Local | √ | × | × | 165 |
| MEC (T2NxM1) | √ | √ | × | 28 | Distant metastasis | × | × | × | 61 |
| ACC (T3N0M0) | √ | × | × | 55 | Local | √ | × | × | 55 |
| Adenocarcinoma, NOS (T3N0M0) | √ | × | × | 72 | Local | √ | √ | √ | 261 |
| SCC (T2N0M0) | √ | √ | × | 29 | Local | √ | √ | √ | 147 |
Abbreviations: ACC, acinic cell carcinoma; C, chemotherapy; MEC, mucoepidermoid carcinoma; NOS, not otherwise specified; R, radiotherapy; S, surgery; SCC, squamous cell carcinoma; √, treated; ×, untreated.
The 1‐, 2‐, and 5‐year overall survival (OS) rates for children and adolescents with malignant parotid tumors were 100.0%, 100.0%, and 94.4%, respectively (Figure 2), and the 1‐, 2‐, and 5‐year locoregional recurrence‐free survival (LRFS) rates were 94.1%, 94.1%, and 72.5% (Figure 3), respectively. The 1‐, 2‐, and 5‐year OS rates of benign tumors were 100.0%, 100.0%, and 100.0%, respectively, and the 1‐, 2‐, and 5‐year LRFS were 100.0%, 100.0%, and 92.9%, respectively.
FIGURE 2.
Overall survival of parotid tumors.
FIGURE 3.
Locoregional recurrence‐free survival rate of parotid tumors.
3.5. Prognostic factors for recurrence
We used the log‐rank univariate test to analyze gender, age, preoperative pain in the parotid region, tumor size, stage, grade, radiotherapy, chemotherapy, and surgery (Table 5). The results showed that the effect of tumor size >3.5 cm (p = .056), distant metastasis (p = .056), and stage III and IV (p = .032) on recurrence was statistically significant.
TABLE 5.
Univariate and multivariate analyses of the recurrence of parotid malignancies in children and adolescents.
| Univariate | Multivariable | |||
|---|---|---|---|---|
| HR (95% CI) | p value | HR (95% CI) | p value | |
| Tumor size | ||||
| ≤3.5 cm | Reference | Reference | ||
| >3.5 cm | 5.885 (0.954–36.308) | .056 | 2.468 (0.208–29.255) | .474 |
| M stage | ||||
| M0 | Reference | Reference | ||
| M1 | 14.967 (0.935–239.649) | .056 | 3.571 (0.170–75.227) | .413 |
| TNM stage | ||||
| Stage I–II | Reference | Reference | ||
| Stage III–IV | 7.119 (1.178–43.029) | .032 | 2.791 (0.227–34.341) | .423 |
| Gender | ||||
| Female | Reference | |||
| Male | 2.040 (0.338–12.327) | .437 | ||
| Age (years) | ||||
| ≥10 | Reference | |||
| <10 | 4.050 (0.415–39.565) | .229 | ||
| Pain a | ||||
| No | Reference | |||
| Yes | 0.022 (0.000–96.117) | .372 | ||
| T stage | ||||
| T1–2 | Reference | |||
| T3–4 | 3.796 (0.625–23.060) | .147 | ||
| Grade | ||||
| Low–intermediate | Reference | |||
| High | 7.131 (0.645–78.797) | .109 | ||
| Lymph node dissection | ||||
| No | Reference | |||
| Yes | 0.026 (0.000–63.047) | .359 | ||
| Radiotherapy | ||||
| No | Reference | |||
| Yes | 0.844 (0.093–7.669) | .880 | ||
Note: Variables with p < .1 on univariate regression were further subjected to multivariate Cox regression analysis, and a p < .05 was considered statistically significant.
Abbreviations: CI, confidence interval; HR, hazard ratio.
Pain in the parotid gland area before surgery.
We performed multivariate analysis to further identify these factors. The results showed that tumor size >3.5 cm, distant metastasis, and stage III or IV seemed to be more likely to develop recurrence, but the difference did not reach statistical significance (p > .1).
4. DISCUSSION
4.1. Clinical features
The incidence of parotid tumors in children and adolescents is very low. In our case, it was even rarer in children under 10 years of age (5/53, 9.4%), which was similar to the proportion in the other studies (10%). 4 , 5 , 6 In our study, the male‐to‐female ratio was almost 1:1, whereas in other studies, the number of females with pediatric parotid tumors was significantly higher than that of males (ratio: 1.58:1 to 2.0:1). 7 , 8 The distribution of benign parotid tumors is different in children, adolescents, and adults. In our case, most of the benign tumors (29/30, 96.7%) were pleomorphic adenomas. The proportion of pleomorphic adenomas in our study was higher than that in relevant reports in adults (46.3%–80.0%). 9 , 10 , 11 Among the malignancies, mucoepidermoid carcinoma was the most common, followed by acinic cell carcinoma, which is slightly different from the pathological types reported in adults, as mucoepidermoid carcinoma, adenoid cystic carcinoma, and parotid duct carcinoma are the most common in adults. 12 , 13 , 14 , 15 , 16 Compared with adults, high‐grade malignant tumors, such as squamous cell carcinoma and parotid duct carcinoma, are less common in children and adolescents, 12 , 17 and only 1 case of squamous cell carcinoma was diagnosed and no case of parotid duct carcinoma was diagnosed in our group.
4.2. Surgical treatment
There are few reports of surgery for benign parotid tumors in children and adolescents, so experience in adults is usually referred to. The extent of resection of benign parotid tumors in adults is usually considered based on factors such as tumor size and location. Our team's previous study of adult parotid tumors found that tumor satellite lesions were the unfavorable pathological features that most affected the thoroughness of surgery. Studies have shown that the distance between satellite lesions and the tumor ranged from 0.06 to 8.48 mm, and this phenomenon was more likely to occur in tumors larger than 4 cm in diameter. Therefore, for pleomorphic adenomas located in the superficial lobe, if the tumor diameter is less than 4 cm, partial resection of the superficial parotid gland can be performed with a safety margin of 1 cm. If the tumor diameter was greater than 4 cm, superficial parotidectomy was recommended. 18 , 19 Quer et al. divided the parotid gland into five levels, the deep and superficial surface of the superficial lobe, the deep and superficial surface of the deep lobe, and the tail of the gland, to determine the extent of surgery. 20 However, more research is needed to confirm whether these surgical approaches are suitable for children and adolescents.
Concerning surgical management of malignant parotid lesions, there is currently a lack of guidelines for pediatric patients, and there is no uniform standard for surgical indications reported in the relevant literatures. Muenscher et al. determined the surgical extent based on tumor staging. 21 Low‐grade malignant tumors could be resected with a 0.5–1 cm resection margin, whereas high‐grade lesions require more thorough surgery. In other studies, the surgery was based on factors such as tumor location and stage. For lesions confined to the superficial lobe, a superficial parotidectomy can be performed; for the deep lobe, a total parotidectomy is required; for nerve involvement, the involved nerve is removed; and for the T4a stage, extended radical parotidectomy is required. 22 , 23 In this study, the extent of surgery was mainly determined by the stage, grade, histological subtype, and recurrence. Of these, most (65.2%) patients with malignant tumors received total parotidectomy, and this proportion was lower than the proportion of adults with malignant parotid glands reported in the relevant literatures (83.4%–87.1%), which may be due to a relatively higher proportion of high‐grade tumors (such as squamous cell carcinoma, parotid duct carcinoma, and sarcomas) in adults. 12 , 17
Regarding the indications for lymph node dissection, the 2024 version of the National Comprehensive Cancer Network (NCCN) guidelines for suggests that lymph node dissection should be performed if there is clinical evidence of lymph node metastasis. However, there is no consensus on whether prophylactic lymph node dissection is needed in patients who are clinically lymph node negative (CN0). 24 The study by Stodulski et al. suggested that lymph node dissection should be performed if the tumor is T3, T4, or high‐grade. 25 Chiaravalli et al. believe that lymph node invasion is relatively rare in children and adolescents, and therefore do not advocate prophylactic lymph node dissection. 3 In our study, we decided whether to perform lymph node dissection and the extent of lymph node dissection based on the patient's characteristics, such as clinical or radiological evidence of possible lymph node metastasis and tumor recurrence. The most common extent of lymph node dissection was I–III levels. In our study, 11 (11/23, 47.8%) patients with malignant tumors received lymph node dissection, which is higher than the proportions reported in other literature (1%–40%). 7 , 26 , 27 However, among these 11 patients, only 1 patient (1/11, 9.1%) with sarcoma (T4aN1M0, stage IVA) had lymph node metastasis, and no patients with other pathological types had lymph node metastasis. This is lower than the lymph node positive rate in pediatric patients with parotid malignancies reported elsewhere (17%) and much lower than the lymph node metastasis rate in adults with parotid malignancies (30.4%–32.9%). 28 , 29 , 30 It is worth noting that in this study, another patient with sarcoma who did not undergo lymph node dissection was found to have lymph node metastasis at follow‐up after treatment. Because the rate of lymph node dissection was high but the rate of positive lymph nodes was low, and because lymph node dissection may cause functional and cosmetic problems, we do not recommend prophylactic lymph node dissection for CN0 patients with low‐grade tumors. However, for high‐grade tumors (such as sarcoma, squamous cell carcinoma, etc.), prophylactic lymph node dissection may be considered.
Frey syndrome and facial palsy are common complications. One (3.3%) patient with pleomorphic adenoma had a recurrence after surgery at another hospital in our study, which was accompanied by facial palsy. During surgery, it was found that the facial nerve and the tumor could not be separated, so the invaded facial nerve was resected and anastomosed. Facial palsy may be related to the previous surgery, to the tumor pressing too hard on the nerve (diameter = 4.8 cm), or to the recurrence of tumors that invade the facial nerve. Similar results were also found in other studies, Zoccali et al. reported that 7 patients (2.7%) with pleomorphic adenoma of the parotid gland have undergone facial nerve resection due to tumor involvement. 31 In this study, facial nerve resection was performed in 1 patient with malignancy. However, 4 patients had permanent facial paralysis at the follow‐up. Whether this is related to the repeated intraoperative retraction of the facial nerve and postoperative radiotherapy still needs further study. In our study, the proportion of permanent facial paralysis was similar to that reported in other literatures (7.7%–11.0%) in children and adolescents after parotidectomy, 27 , 32 and higher than that reported in adults (1.9%–4.1%). 33 , 34 , 35 This may be because the facial nerve in pediatric patients is shallower and more likely to be injured, or because they are more sensitive to nerve resection and traction. 36 Regarding the prevention of Frey syndrome, in addition to the implantation of temporoparietal fascia or superficial musculoaponeurotic system flap between the parotid fascia and the residual parotid gland, which has a good effect, 37 our team's previous study also found that the use of sternocleidomastoid muscle flap, implantation of acellular dermal matrix graft, or free fat graft was effective in preventing postoperative facial depression and Frey syndrome. 19 , 38 , 39
4.3. Radiotherapy
In this study, some patients (8/23, 34.8%) received postoperative radiotherapy, which is lower than the proportion of adults with malignant parotid tumors (54.5%–64.3%). 13 , 30 , 40 There is no consensus on whether children and adolescents with malignant parotid tumors should receive radiotherapy, and indications are mainly derived from studies in adults. 23 According to the 2024 version of the NCCN guidelines for the general population, the indications for radiotherapy are adenoid cystic carcinoma, intermediate‐ or high‐grade tumors, close or positive margins, neural/perineural invasion, lymph node metastasis, vascular/lymphatic invasion, T3–4a tumors, and tumors that are not completely removed. 24 In our cases, the patients who received radiotherapy usually had the following conditions: high‐grade tumor, lymph node metastasis, nerve invasion, or incomplete tumor resection. In our study, the patients who received radiotherapy recovered well at follow‐up, and no significant jaw dysplasia or facial deformity was observed. However, because radiotherapy may cause complications such as pigmentation and salivary gland dysfunction, we recommend cautious use of radiotherapy in children and adolescents with malignant parotid tumors, and radiotherapy is considered in patients with high‐risk factors.
4.4. Chemotherapy
The role of chemotherapy in the treatment of children and adolescents with parotid malignancies is currently unclear. Common chemotherapeutic agents include platinum, doxorubicin, cyclophosphamide, etc., which are usually used for advanced and recurrent diseases. 3 , 41 , 42 In our study, chemotherapy was generally considered for high‐grade tumors and locally advanced cases (T3 or T4). Therefore, further studies are needed to verify the indications, safety, and efficacy of chemotherapy in children and adolescents.
4.5. Prognosis
In our study, benign parotid tumors had a good prognosis, with 5‐year LRFS and 5‐year OS rates of 92.9% and 100.0%, respectively. Whereas malignant tumors had a good OS but a higher recurrence rate, with 5‐year OS and 5‐year LRFS rates of 94.4% and 72.5%, respectively. Compared with other reports in pediatric patients, the 5‐year OS rate of malignant parotid tumors was similar to ours (94%–96%), 4 , 43 but higher than that reported in adults (70.0%–74.7%). 40 , 44
One study found that tumor stage and preoperative symptoms were important factors for tumor recurrence and death. 26 However, in our study, we observed that patients with tumor size greater than 3.5 cm, distant metastasis, and stage III and IV were more likely to develop recurrence, but multivariate analysis showed that these differences were not statistically significant. A possible explanation could be the limited sample size, which could lead to biased results.
4.6. Relapse treatment
In our study, the follow‐up of 20 patients with malignant tumors showed that 5 of them had a recurrence (25.0%) and the median time to recurrence was 2.4 years. In comparison, the study by Zamani et al. reported a recurrence rate of 20% and a median time to recurrence of 1.1 years. 43 Irrespective of whether the tumor was benign or malignant, all patients underwent surgery except for 1 patient with mucoepidermoid carcinoma who withdrew due to lumbar metastasis. Among them, 2 patients with malignant tumors received lymph node dissection, and some patients received chemotherapy and radiotherapy. Due to local tissue adhesion in the second operation, the risk of facial nerve injury is increased, so the separation should be performed close to the nerve to avoid excessive stretching. After receiving treatment in our hospital, 4 patients with recurrent malignant tumors had no recurrence, whereas 1 patient with pleomorphic adenoma had three recurrences. We thought that this recurrence might be related to the rupture or incomplete resection of the tumor. Recurrent pleomorphic adenomas are often multiple nodules and total parotidectomy is recommended. However, surgery alone may not be effective in controlling recurrence. One study found that postoperative radiotherapy could significantly improve local control. 45 However, our study did not verify the efficacy of radiotherapy for recurrent pleomorphic adenoma, which is also one of our future research directions.
5. CONCLUSION
Pleomorphic adenoma is the most common benign tumor of the parotid gland in children and adolescents, whereas mucoepidermoid carcinoma is the most common malignant tumor. Surgery is the main treatment. For benign tumors located in the superficial lobe of the parotid gland, if the tumor is less than 4 cm, partial resection can be performed with a safety margin of more than 1 cm; for tumors larger than 4 cm, superficial parotid resection is recommended. For parotid malignancies, surgical approach usually depends on the stage, grade, pathological type, and recurrence. If there is lymph node metastasis on preoperative examination, lymph node dissection may be considered. Prophylactic lymph node dissection may be performed for high‐grade malignancies. There is currently no agreed standard for postoperative radiotherapy or chemotherapy. In general, radiotherapy may be considered for high‐grade malignancies, lymph node or nerve involvement, or incomplete resection. Chemotherapy may also be considered for high‐grade tumors and advanced patients. However, there are currently no clear guidelines on the choice of surgery, radiotherapy, and chemotherapy in pediatric patients. Therefore, multicenter trials with large numbers are needed to provide more reliable evidence.
FUNDING INFORMATION
This work was supported by the Major Science and Technology Project Foundation of the Science and Technology Department of Sichuan Province (2019YFS0337).
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Liu L, Xiang Y, Shui C, et al. Long‐term follow‐up and prognostic analysis of parotid tumors in children and adolescents. Laryngoscope Investigative Otolaryngology. 2024;9(3):e1275. doi: 10.1002/lio2.1275
Contributor Information
Chao Li, Email: lichao@scszlyy.org.cn.
Yongcong Cai, Email: caiyongcong@scszlyy.org.cn.
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