Table 1.
Management of parotid tumors – levels of evidence.
| Step of management | Comment | Evidence level |
| Diagnostics | ||
| Clinical examination | Important for the differentiation between benign and malignant tumor: fast growing, facial palsy, pain, fixation are signs of malignancy | Cohort studies |
| Ultrasound and fine-needle aspiration cytology | Accurate for benign superficial tumors | Cohort studies, meta-analysis of cohort studies |
| MRI | Accurate for large tumors, deep lobe tumors, malignant tumors | Cohort studies |
| Core needle biopsy | Alternative if fine-needle aspiration cytology is not available of if the cytopathologist suggests that fine-needle aspiration cytology is not sufficient for diagnosis | Cohort studies |
| Frozen sections | Alternative if fine-needle aspiration cytology is not available or if fine-needle aspiration cytology was not conclusive | Cohort studies, meta-analysis of cohort studies |
| Treatment | ||
| Wait-and-scan | For selected cases of Warthin tumors | Descriptive studies |
| Partial or superficial parotidectomy | For benign tumors in the superficial lobe | Cohort studies, meta-analysis of cohort studies |
| Extracapsular dissection | For selected benign tumors in the superficial lobe | Cohort studies, meta-analysis of cohort studies |
| Total parotidectomy | For benign tumors of the deep lobe, extension into the parapharyngeal space, malignant tumor without facial nerve infiltration | Cohort studies |
| Radical parotidectomy | For malignant tumor with facial nerve infiltration | Descriptive studies |
| Curative neck dissection | For cN +parotid cancer including level I-V | Cohort studies |
| Elective neck dissection | For cN +parotid cancer, at least level I-III | Cohort studies |
| Facial nerve rehabilitation | If reconstruction is possible in case of parotid cancer with facial nerve infiltration as single stage procedure | Descriptive studies |
| Radiotherapy, adjuvant | For all cases of advanced-stage disease (T3/T4), high-grade tumors, always for adenoid cystic carcinoma, close or positive margins, bone invasion, lymph node metastases (more than three metastatic nodes), perineural and/or vascular invasion | Cohort studies |
| Radiotherapy, definitive | For non-resectable parotid cancer | Mainly cohort studies, a few non-randomized controlled trials |
| Chemotherapy, adjuvant | No effectivity is adjuvant therapy together with radiotherapy, compared to adjuvant therapy alone | Cohort studies |
| Chemotherapy, palliative | Low effectivity | Descriptive studies |
| Biologicals | No clear demonstration of effectivity in metastatic/recurrent parotid cancer | Small controlled non-randomized phase I-II trials |