Facial Nerve Sacrifice and Radiotherapy in Parotid Adenoid Cystic Carcinoma

Objectives: To evaluate the impact of facial nerve sacrifice and postoperative radiotherapy on the outcome of adenoid cystic carcinoma of the parotid gland. Study Design: Inception cohort. Methods: Retrospective review of Department of Pathology, SNOMED database, and Tumor Registry including health-related quality of life data for the subset enrolled in the longitudinal Outcomes Assessment Project. Fisher exact, X, and Wilcoxon tests were used to determine significant differences. Results: Fifty-two cases (follow-up mean: 9.1 years, range: 0.5-40.8 years) demonstrated local control rates of 84.6% (5 years), 76.9% (10 years), and 50% (20 years). Compared with facial nerve preservation, facial nerve sacrifice had better control at 5 years (100 vs. 78.9% P = .259) while having detrimental effects on eating, speech, and esthetics. Local control at 5 years was significantly better (P =.048) with postoperative radiotherapy (100%) than without (84.6%). Overall survival was 79.4% (5 years), 50% (10 years), and 32.3% (20 years). At 10 years, there was a trend toward improved survival with facial nerve sacrifice (58.8 vs. 46.8%, P =.569) and postoperative radiotherapy (62.4 vs. 39.3%, P =.409). Eleven patients with lung metastases survived an average of 67.8 months after metastases were identified. Only 4 of 46 patients NO patients (8.3%) subsequently developed lymph node metastases. Conclusion: Selective facial nerve sacrifice was associated with trends toward improved local control and survival but worse quality of life. Patients managed with postoperative radiotherapy had better local control rates than those without. NO patients rarely developed metastases to regional lymph nodes.