2.  Gender: Female  Age: 35  James  Oncor

3.  Single  Smoked for 8 years  Quit in 2004  No alcohol or drug use  Family  Mother: breast cancer  Sister: thyroid cancer  Maternal Grandfather: prostate cancer  Paternal Grandfather: prostate cancer  Parotidectomy for a benign growth in 2010 & recovered fully (OSU has requested review)  No other medical history listed

4.  Presented with a mass in the right parotid region  Facial nerve synkinesis  Abnormal involuntary facial movement that occurs with voluntary movement of a different facial muscle group  Lip elevation with blinking

5.  Shooting pains in V2 distribution  Sensation of cold water on face when eating  No facial weakness or numbness  No weight loss, fevers, or lymphadenopathy (abnormal lymph nodes)

6. MRI Before Parotidectomy MRI After Parotidectomy

7.  MRI

8.  Axial contrast-enhanced CT scans (sup.  inf.)

9.  Salivary gland tumors make up 6% of all head and neck tumors (>1% overall)  700 deaths annually  80% in the parotid glands  Of which 80% are benign  Most commonly in the 6 th decade of life  Malignant Older than 60 Equally distributed between sexes  Benign Older than 40 More prevalent in females

10.  Risks:  Radiation Therapy in low doses (15-20 years later)  Occupational exposure to silica and dust  Older age  Possibility of family history, high fat diet, cell phone use links  Smoking and alcohol are highly associated with head and neck squamous cell carcinoma but no link to salivary gland malignancies  Not fully understood

11.  Weakness of the muscles on one side of your face  Trouble opening your mouth widely  Fluid draining from ear  Trouble swallowing

12.  1 of the 3 major salivary glands  1. Parotid  2. Submandibular  3. Sublingual  Anterior to the mandibular ramus  Divided into superficial and deep lobes  Drains to the oral cavity through Stenson’s Duct (parotid duct)

13.  Pre-auricular  Infra-auricular  Deep jugular

14.  Acinic cell adenocarcinoma of right parotid gland  Mucoepidermoid CA (adenocarcinoma) is the most common histology for parotid malignancy  Low grade

18.  Surgery most common  She recently had a revision of her previous parotidectomy Positive margins  Radiation Therapy if inoperable or post op.  IMRT  Photon & Electron  Wedge pair  Dose: 60-70 Gy  Loss of salivary function in gland after 35 Gy

19.  Total Dose: 60 Gy  30 fractions  20 Gy/fraction  6 Field IMRT  No supraclav

24.  Supine  Conformal board  Head and shoulder aquaplast mask  Custom head rest  Knee sponge

25.  Long Term:  Decrease in thyroid function  Decreased hearing  Loss of taste  Swelling in neck/jaw  Scar tissue  Decrease mobility of neck/jaw  Brain stem injury  Damage to larynx  Damage to brachial plexus  Damage to neck vessels  Long Term:  Decrease in thyroid function  Decreased hearing  Loss of taste  Swelling in neck/jaw  Scar tissue  Decrease mobility of neck/jaw  Brain stem injury  Damage to larynx  Damage to brachial plexus  Damage to neck vessels At 44 Gy

26.  Major determinants of survival are history and clinical stage  Overall 5-year survival for all stages and histologic types is approximately 62%  The overall 5-year survival for recurrent disease is approximately 37%

27.  20% of patients with parotid gland tumors will develop distant metastasis  Most common site is the lungs  Can have many metastatic sites Chemo would most likely be used in this situation

28.  American Cancer Society. Salivary Gland Cancer. N.p.: American Cancer Society, 2014. PDF.  Amirlak, Bardia. "Malignant Parotid Tumors." MedScape. WebMD, 27 Feb. 2013. Web. 18 Mar. 2014..  Hackworth, Ruth. "Paranasal Sinuses and Orbits." Feb. 2014. Lecture.  Lee, Steve. "Salivary Gland Neoplasms." MedScape. WebMD, 8 Mar. 2013. Web. 18 Mar. 2014..