New Insights in Parotid Tumors

Dear Colleagues,

Salivary gland neoplasms represent approximately 3% of all head and neck tumors and can arise from both major and minor salivary glands. Parotid tumors account for 85% of these neoplasms and are more frequently benign (80%), with pleomorphic adenoma being the most common benign histotype, followed by Warthin tumors. Pleomorphic adenomas may present a malignant transformation. In order to achieve the complete resection of a tumor, surgery represents the first-line treatment and can vary from extracapsular dissection (ECD) to extended ECD, and to partial or total parotidectomy with or without neck dissection, based on the tumor’s location, extension and preoperative characterization. Surgery also aims to preserve the facial nerve, if possible. Performing a preoperative evaluation is crucial in the planning of treatment and relies on clinical examination, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound guided fine-needle aspiration cytology; however, none of these techniques can distinguish malignant lesions from benign lesions with absolute reliability. Some research has already focused on advanced CT and MRI techniques and on radiomics in the differential diagnosis of parotid tumors; however, these methodologies show highly variable sensitivities, specificities, positive predictive, negative predictive and accuracy values when distinguishing malignant from benign tumors.

The treatment of malignant parotid tumors is challenging due to the rarity and heterogeneity of this disease and the complexity of the anatomy. Therefore, recent recommendations regarding the surgical management of this disease enable both the primary tumor and neck lymph nodes to be managed in different ways, such as in low- and high-grade tumors. In higher staged malignant tumors, neoadjuvant or adjuvant chemotherapy and radiotherapy may be required. Due to technological advancements in radiation planning and delivery, the future of parotid gland management may increasingly involve non-surgical treatments. This could include the integration of modern forms of photon therapy, brachytherapy, particle therapies and radionuclides alongside the development of novel systemic drug therapies in both adjuvant and definitive treatment programs.

This Special Issue will provide novel insights into the diagnosis and preoperative evaluation of parotid tumors with the aid of advanced imaging techniques and artificial intelligence tools, the application of surgical techniques and reconstruction methods, and the utilization of neoadjuvant and adjuvant therapeutic techniques that improve outcomes in these patients.

Dr. Chiara Gaudino
Prof. Dr. Stefan Rohde
Guest Editors

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