Diagnosis and management of parotid carcinoma with a special focus on recent advances in molecular biology.

Recent progress in diagnosis, treatment, prognosis, and outcome of parotid cancer is reviewed. Modern imaging allows evaluation of the anatomical extent of the cancer and its relationship to the facial nerve, and the World Health Organization (WHO) Histological Classification facilitates accurate, consistent diagnosis. Surgery remains the treatment of choice with preservation of a functioning facial nerve. Resection of the facial nerve should only be undertaken when there is clinical evidence of nerve dysfunction. The NO neck should be treated in advanced-stage and high-grade cancers, but the choice between elective surgery and elective irradiation remains controversial. Low-stage, low-grade tumors can generally be cured by surgery alone. Postoperative radiotherapy improves locoregional control in all other tumor stages and grades. Currently, the diagnostic and therapeutic approach to parotid cancer offer few options for a class of neoplasms that has many subtypes each with a unique molecular background and variable clinical behavior. Nonetheless, this approach results in a satisfactory locoregional cancer control, making distant metastasis the most frequent cause for treatment failure. At present, systemic treatment for distant failure is disappointing, although recent progress in molecular biology has suggested that adding targeted therapy should achieve tumor response or stabilization. Although disease control remains variable, the prognosis of individual patients can be increasingly accurately predicted by multivariate analysis.