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this, we conducted a standardized phone survey and approximately
a quarter of the patients in our series participated. This allowed for
an average follow up time of 28.7 years in this group, which is
longer than any published study. Our data suggest that, overall;
children treated for parotid malignancies have minimal long term
sequelae. None of the surveyed patients reported current facial
weakness or eye problems. There was a high rate of persistent
Frey's syndrome in our series at 54%. This compares to other series
which report an incidence of 2e47% in pediatric patients [3,7],
however, Frey's syndrome may be under-represented in these
retrospective studies due to reporting bias. A quality of life survey
study by Feng et al. found that 9% of patients with pediatric parotid
tumors reported Frey's syndrome at an average follow up time of
8.5 years. However all their patients underwent superficial paro-
tidectomy and only 12% had malignant tumors [12] . Our results
concur with this series in that patients reported that their Frey's
syndrome had a minimal impact on their quality of life.
6.2. Minor gland
Lastly, patients with minor salivary gland malignancies in our
series fared much worse than those with major gland tumors.
Recurrence in this group was 75% and rate of distant metastases
and death was 50%. Due to the small number of patients in our
series with minor gland tumors (n ¼ 4), conclusions are difficult to
make. A larger series of 35 children by Galer et al. revealed a more
favorable prognosis with a recurrence rate of 11% and overall
disease-specific survival of 88.4% at 5 years [13] . More studies
should be conducted on this topic; however, we would favor a more
aggressive management strategy in these patients.
A potential limitation is the retrospective nature of our study
which could cause information on outcomes and complications for
those who did not participate in the survey to be limited by loss of
follow up or interview/reporting bias. A strength of this study is the
comparably large number of patients as malignant salivary tumors
are uncommon in children and each institution has limited case
numbers. Our series has the longest reported follow up of its kind
(mean ¼ 14 years) with the addition of 23% of patients responding
to a formalized long term outcome and quality of life survey.
7. Conclusion
We report a single institution's experience with pediatric sali-
vary malignancies over a 62 year time period with the longest post
treatment follow up in the currently published literature. We found
that the majority of these tumors are low grade and have excellent
survival if found at an early stage. In our series, minor salivary gland
malignancies, particularly high grade, tended to do worse. Primary
treatment should be surgery with every attempt to spare the facial
nerve unless grossly involved by tumor. Radiation therapy should
be administered sparingly and only when strongly indicated, as
there is a high potential for long term morbidity. Recurrence in our
series was more likely with the presence of adverse pathologic
features and enucleation versus total parotidectomy. On long term
follow up, our patients had good facial movement and were
without eye complications. Future studies should attempt to pool
patients from multiple institutions in order to further investigate
ideal treatment algorithms.
Financial disclosures
None to report.
Conflicts of interest
None to report.
Acknowledgements
The authors would like to thank Nicole Tombers, and Adam
Bartley for their assistance with this project.
The authors have no relevant financial disclosures.
Cara Cockerill had full access to all the data in the study and
takes responsibility for the integrity of the data and the accuracy of
the data analysis.
Appendix 1. Description of patients with a local recurrence e
major gland
Pt# T stage, pathology Initial treatment Time to recurrence
(months)
Recurrence treatment Outcome Length of follow up
(years)
1 T3, high grade MEC with
ECS
1. Enucleation
(OSH)
2. TP with FN rsxn
and ND
9.5 RP and placement of radon beads Alive
NED
6
2 T2, MEC TP with FN rsxn 8.8 RP Alive
NED
11
3 T1 low grade MEC SP with ND 22.4 1. RP and ND
2. Recurred again 9 months later, treated with RP and radon
beads
Alive
NED
11
4 T1 low grade acinic cell Enucleation 31.9 TP Alive
NED
20
5 Tx low grade acinic cell Enucleation (OSH) 15.9 TP and ND Alive
NED
20
6 T1 low grade MEC SP (OSH) 9.8
2. Recurred again 4 years later. Treated with RP.
Alive
NED
18
7 T1 low grade MEC Enucleation (OSH) 2.9 SP (OSH) Alive
NED
1
8 T1 intermediate grade MEC Enucleation (OSH) Unknown TP and ND Alive
NED
2
9 T3 intermediate grade MEC
with ECS
9.2 Partial temporal bone resection Alive
NED
2
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