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7. Conclusion

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 2 e 47% 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 super fi cial 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. 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 dif fi cult 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-speci fi c 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. 6.2. Minor gland

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.

Con fl icts 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 fi nancial 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 Alive NED Alive NED Alive NED Alive NED Alive NED

20

5 Tx low grade acinic cell

Enucleation (OSH) 15.9

TP and ND

20

6 T1 low grade MEC

SP (OSH)

9.8

1.TP 2. Recurred again 4 years later. Treated with RP.

18

7 T1 low grade MEC

Enucleation (OSH) 2.9

SP (OSH)

1

8 T1 intermediate grade MEC Enucleation (OSH) Unknown

TP and ND

2

9 T3 intermediate grade MEC with ECS

9.2

Partial temporal bone resection

2

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