Management algorithm for HIV-associated parotid lymphoepithelial cysts.

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.

[Radiotherapy : an option for refractory salivary fistulas]. / Radiatio : Therapieoption bei therapierefraktärer Speichelfistel.

A 45-year-old patient presented with refractory salivary fistula, attributed to multiple surgery and Botulinum toxin, following lateral parotidectomy. He underwent fractionated radiotherapy of the remaining parotid gland including the fistula opening (total dose of 30 Gy) at our clinic. In time, fistula secretion could be inhibited completely. Although the indication for radiotherapy for such fistulas is rare since Botulinum toxin has been in use, it should still be considered in refractory disease courses.

Laser as a therapy for dry mouth symptoms in a patient with Sjögren's syndrome: a case report.

This clinical case study reports on dry mouth symptoms in a patient with Sjögren's syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.

Radiation therapy as a treatment for benign lymphoepithelial parotid cysts in patients infected with human immunodeficiency virus-1.

Patients who are infected with the human immunodeficiency virus (HIV) may develop benign lymphoepithelial cysts within the parotid gland that cause severe facial deformity. Standard treatment for this disorder has been superficial parotidectomy, repeated fine-needle aspirations or observation alone. These approaches are unsatisfactory because elective surgery in immunocompromised patients should be avoided, the cysts recur soon after aspiration, and observation alone for a treatable deforming facial process is unacceptable. Radiotherapy's proven effectiveness in treating other benign disorders of the parotid gland led us to evaluate its usefulness as a treatment for this disorder. Eight patients with parotid enlargement, who were seropositive for HIV, received 8-10 Gy to the parotids in 1 week. Five patients had complete response and three patients had partial response. All were very satisfied with the cosmetic result. Treatment-related toxicity was well tolerated and consisted of mild xerostomia and transient taste loss. In all cases, these side effects resolved within 1 month. Radiation therapy thus appears to be an effective and well-tolerated treatment for AIDS-related parotid enlargement.

Late radiation side-effects in three patients undergoing parotid irradiation for benign disease.

We report three patients in whom standard radiation therapy was given and serious late radiation damage was seen. The first patient suffered recurrent parotiditis and a parotid fistula. He was treated initially with 20 Gy in ten fractions via a 300 kV field. Further irradiation was required 1 year later and 40 Gy was given in 2 Gy fractions by an oblique anterior and posterior wedged photon pair. Ten years later he developed localized temporal bone necrosis. The second patient, with pleomorphic salivary adenoma, developed localized temporal bone necrosis 6 years after 60 Gy had been given using standard fractionation and technique. The third patient received 55 Gy in 25 fractions for a pleomorphic salivary adenoma and after 3 years developed temporal bone necrosis. Sixteen years later the same patient developed cerebellar and brainstem necrosis. All patients developed chronic persistent infection during or shortly after the radiation therapy, which increased local tissue sensitivity to late radiation damage. As a result, severe bone, cerebellar and brainstem necrosis was observed at doses that are normally considered safe. We therefore strongly recommend that any infection in a proposed irradiated area should be treated aggressively, with surgical debridement if necessary, before radiotherapy is administered, or that infection developing during or after irradiation is treated promptly.

Role of irradiation in the suppression of parotid secretions.

Suppression of salivary flow is of value in the management of salivary fistulae and sialectasia. It may also be beneficial in mentally defective patients and those with neurological palsies lacking control of their salivation. Nine patients were treated by irradiation to the parotid gland to control salivary flow; eight had complete resolution of symptoms and one had partial relief. Irradiation was effective as primary treatment and after failed surgery and/or drug treatment. Low doses were effective and there were no significant acute or long-term side effects. Its use avoids long-term medication and their potential side effects and may reduce the need for surgery.

Post-irradiation liposarcoma of the temporal bone.

The first reported case of liposarcoma of the temporal bone is presented. Its association with previous irradiation for benign parotid disease is discussed.

[Malignant change in the lymphoepithelial lesion of the parotid gland--report of 3 cases].

3 rare cases of malignant change of lymphoepithelial lesion (Mikulicz's disease) of parotid gland are presented. 1 was male and 2 female. Their ages ranged from 40 to 71 with an average of 57 years. All were pathologically proved. The common clinical manifestations were local painless masses. 2 of the 3 cases were treated only by local excision. Extended excision with simultaneous neck dissection of the metastatic lymph nodes was done in the remained one. All patients received postoperative radiotherapy at doses of 3,000-5,000 rad over 19 to 36 days. One of them died 2.5 years later. The other two are still living without evidence of recurrence more than 3 and 8 years respectively. The prognosis of malignant Mikulicz's disease is probably better than that of parotid carcinoma. The authors suggest that the treatment of this disease, especially in those with regional metastasis, be managed according to the same principle of parotid cancer. Postoperative radiotherapy should be given as a routine for still better results. The clinico-pathologic features and pathogenesis of this disease are discussed briefly.

Radiation therapy for Benign Lymphoepithelial Cysts of parotid glands in HIV patients.

OBJECTIVES/HYPOTHESIS: To report the long-term outcomes of radiation therapy (RT), and the impact of fractionation size and RT duration on HIV patients with Benign Lymphoepithelial Cysts (BLEC) of the parotid glands. METHODS: From January 2000 to 2011, 30 patients were eligible for our single institution retrospective study. Both parotids were treated with 24 Gy via RT. The median age at RT, HIV diagnosis, and duration of HIV seropositive was 45 years (28-64), 38 years (23-53), and 11 years (6-35), respectively. Patients were stratified into two groups. Group A and B received 2Gyx12 and 1.5Gyx16, respectively. RESULTS: After a median follow-up of 66 months (12-141), the overall response (OvR) was 93% of the patients. Specifically, complete response (CR) and partial response (PR) were 80% and 13%, respectively. In group A, 100% had CR. Treatment failure was 7% and all were in group B, which was mainly due to poor compliance. A Chi-square test showed significant relationship between OvR and RT duration (P <0.001), and a positive trend between CR and fraction size of 2 Gy (P = 0.053). All acute toxicities were grade ≤ 2, specifically mucositis (48%), xerostomia (45%), skin erythema (41%), and altered taste (14%). Two patients (6.7%) experienced long-term grade 1 xerostomia. CONCLUSION: RT provides a sustained long-term cosmetic control for BLEC of the parotid glands in HIV patients. Failures are uncommon, and the late side effects have been negligible.

Clinical management of masses arising from the accessory parotid gland.

OBJECTIVE: Accessory parotid lesions are clinically rare and its management remains poorly understood. The aim of this study was to analyze the clinical management of accessory parotid lesions. STUDY DESIGN: From April 1999 to November 2008, a retrospective analysis of 32 patients with accessory parotid lesions was performed. The preoperative examinations, surgical treatment, and prognosis were recorded and analyzed. RESULTS: Among the 32 patients, there were 8 men and 24 women with an overall average age of 45 years. These patients always presented without obvious symptoms, and the masses were moderate to hard in hardness without tenderness, mobile, and with clear boundary. The pathologic diagnoses were 24 benign and 8 malignant lesions. Surgery and surgery plus radiotherapy were performed in the patients with benign and malignant lesions, respectively, with good prognosis. CONCLUSIONS: Accessory parotid lesions are rare, and the clinical manifestation is always the same for benign tumors. Surgical resection and surgical resection plus radiotherapy are the primary choices of treatment for benign and malignant lesions, respectively. The prognosis is always good.

[The radiotherapy of Castleman's lymphoma]. / Strahlentherapie des Castleman-Lymphoms.

The angiofollicular lymphoid hyperplasia, first described by Castleman, is a benign lymphoma. The authors report a very rare case of Castleman lymphoma in the parotid gland. The tumor was successfully irradiated with 40 Gy fast electrons. Treatment planning and therapy monitoring were done by means of ultrasound and computed tomography.

Low-dose radiotherapy for multicystic benign lymphoepithelial lesions of the parotid gland in HIV-positive patients: long-term results.

BACKGROUND: Multicystic benign lymphoepithelial lesions of the parotid gland (BLL) seen in patients with human immunodeficiency virus (HIV) can produce considerable cosmetic deformity as well as physical discomfort. We previously reported our preliminary results with low-dose radiotherapy in this disease, and all 8 patients were satisfied with the initial improvement in their appearance. We now report the long-term follow-up of those patients and additional patients. METHODS: Twelve HIV-positive patients with BLL were treated with 8-10 Gy of external radiation using 2-Gy daily fractions. Objective responses and subjective duration of patient-defined cosmetic control were recorded. RESULTS: All 12 patients (100%) had at least a 50% decrease in the size of their parotid masses. Five of 12 (42%) had a complete response and 7 (58%) had a partial response. Persisting complete response was achieved in only 1 patient, however, with relapse in the other 11 patients. Cosmetic palliation, as judged by the patients, was achieved for a median of 9.5 months. Eight patients were subsequently retreated with doses of 6-16 Gy (median and mode: 10 Gy). None (0%) of the 8 patients retreated achieved local control. CONCLUSIONS: Very low-dose radiation (8-10 Gy) provides reliable but temporary cosmetic palliation for BLL. Retreatment was unsatisfactory, and we are now investigating higher initial doses of radiation to prolong palliation and eliminate recurrences.