A lady of 31 yr old presented in ent opd with right side preauricular swelling of 3*3 size from 3 year back..there was no other symptoms associated with swelling, no compromise of any function.. On fnac of swelling , it comes out to be WARTHIN TUMOUR.. On CT there was soft mass lesion not eroding any nearby structure.. She undergone superficial parotidectomy for that.. Post operative ,the biopsy report of sample came out low grade mucoepidermoid carcinoma.. Ent surgeons decided for revision surgery- total conservative parotidectomy.. During operation, ent surgeons found facial nerves completely engulfed by patotid tissue so they left tumour tissue as it is because of danger of facial nerve damage.. Post operative - ent surgeons decided for radiochemotherapy .. Past history- there is hostory of acoustic neuroma at cp angle 15 yrs back ..it was treated conpletely with surgery nd x-knife..complication of surgery was facial palsy on left side... Some doctors are saying there is no need of radiotherapy in low grade mucoepidermoid carcinoma; nd doctors who operated says its necessary.. Wat should be done for this patient??
Have they resected the tumor and left some remnants due its engulfment to the facial nerve or have they left the tumor as a whole? Post-operative radiation is essential in this type of carcinoma. It decreases the chance of recurrence and metastasis. If the tumor was not resected it is highly recommended against radiotherapy alone as the primary therapy. And in this case a surgery must be done to totally remove the tumor tissue, so I suggest you seek another surgeon advice. Here are few links of studies that elaborate more on treatment modalities of mucoepidermoid carcinoma and outcomes: http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/647774 https://academic.oup.com/jjco/article/38/6/414/843062/Mucoepidermoid-Carcinoma-of-the-Head-and-Neck
OK so part of the tumor was resected to perserve the facial nerve since she's having facial palsy on the other side of her face. There are no other options for her but radiotherapy and close follow up for metastasis or recurrence. Although the biopsy after the second operation came out clear there might be some microscopic tumor tissue. So radiotherapy is recommended to avoid recurrence and metastasis. Studies found that surgery with post-operative radiotherapy improves outcome and prognosis compared to surgery alone. And please bare in mind that this is not my personal opinion nor recommendation, my comments are based on studies and not experience. Please read the attached links of studies above for more details.
