한줄요약: Superficial parotidectomy is the treatment of choice for pleomorphic adenomas arising in the parotid gland.

https://www-uptodate-com.libproxy.hallym.or.kr/contents/salivary-gland-tumors-treatment-of-locoregional-disease?search=salivary%20gland%20tumors&source=search_result&selectedTitle=3~42&usage_type=default&display_rank=3#H17

PLEOMORPHIC ADENOMAPleomorphic adenoma, also known as benign mixed tumor, is the most common salivary gland tumor. The majority of these tumors occur in the superficial lobe of the parotid gland. Pleomorphic adenoma has historically been characterized as having a propensity for local recurrence and a potential for malignant transformation to the so called "carcinoma ex pleomorphic adenoma." (See "Salivary gland tumors: Epidemiology, diagnosis, evaluation, and staging" and "Pathology of head and neck neoplasms", section on 'Salivary gland tumors'.)

Superficial parotidectomy is the treatment of choice for pleomorphic adenomas arising in the parotid gland. The recurrence rate after simple enucleation is 20 to 45 percent; with superficial parotidectomy, recurrence rates are reduced to less than five percent [75,76]. For most pleomorphic adenomas, a more extensive procedure (total parotidectomy) does not reduce the risk of recurrence further and is associated with higher rates of facial nerve dysfunction and other complications [75,77,78].

Positive margins, capsule rupture, and tumor spillage have been implicated as potential causes for high recurrence rates, and these should be avoided when possible. However, positive margins are common after resection of this tumor; these occur because of an incomplete tumor capsule, a tendency of the tumor to form perforating pseudopodia, and close proximity of the tumor to the facial nerve [4,75,79].

Rarely, pleomorphic adenoma has been reported to metastasize to the lung, bone, and elsewhere. Furthermore, carcinoma ex pleomorphic adenoma, an aggressive malignancy, may arise in a small percentage of pleomorphic adenomas. Evidence suggests that the occurrence of both is related to incomplete or inadequate primary surgery [80]. (See "Pathology of head and neck neoplasms", section on 'Salivary gland tumors'.)

Recurrent pleomorphic adenomas are treated with resection, but the likelihood of control diminishes with each subsequent surgery while the morbidity increases [81-84]. These include facial nerve dysfunction, Frey syndrome, salivary fistula, and necrosis [77,84].

The role of postoperative radiation following resection of recurrences is debated, but improved local control with postoperative radiation therapy (RT), particularly for positive margins and/or multinodular recurrence, has been reported [77,79,81]. Although reresection should be performed, if possible, for positive margins, many experts would consider postoperative RT for patients with recurrent pleomorphic adenoma and positive margins, depending upon factors such as rapidity of recurrence, patient age, and completeness of resection. Unresectable recurrences are also treated with RT. RT doses used for pleomorphic adenomas are generally lower than for carcinomas, 50 to 54 Gy in 1.8 to 2.0 Gy fractions.

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