Squamous Cell Carcinoma Metastatic to the Lymph Nodes of the Parapharyngeal Space: Case Series and Systematic Review

Overview

Journal Acta Otorhinolaryngol Ital

Specialty Otorhinolaryngology

Date 2024 Sep 30

PMID 39347547

Authors

Matteo Fermi

Cecilia Botti

Francesco Chiari

Andi Abeshi

Livio Presutti

Matteo Miglio

Francesco Mattioli

Daria Maria Filippini

Sara Valerini

Daniele Marchioni

Gabriele Molteni

Edoardo Serafini

Affiliations

Soon will be listed here.

Abstract

Objective: Parapharyngeal space (PPS) is a rare and unusual site of head and neck squamous cell carcinoma (SCC) metastases. Treatment strategy for PPS metastases is still not well defined. This research aims to investigate the clinical implications and oncological outcomes of SCC metastases in PPS.

Material And Methods: A systematic review was conducted according to PRISMA criteria. The authors considered only articles reporting the history and treatment of patients with PPS SCC metastases. A retrospective chart review was conducted in two tertiary referral academic centers collecting data of patients with diagnosis of PPS SCC metastases between 2010 and 2023 to study their outcome based on clinical presentation and treatment strategy.

Results: The retrospective chart review showed that the oropharynx was the most frequent primary tumour site. The advanced stage at the time of diagnosis was related to poorer survival and higher recurrence rates. A significant difference in 2-year overall survival in the subgroup of patients who experienced PPS metastases within the primary treatment and those who experienced PPS metastases as regional recurrence (66.7 30.8%) was observed. Similar low survival rates were reported in the literature review with a mean overall and disease-free survival of 19.8 and 8.6 months, respectively.

Conclusions: PPS metastases are associated with a dismal prognosis, especially when diagnosed as regional recurrence after primary treatment, due to patients' poor general conditions and difficulty of treatment.

Citing Articles

Parapharyngeal space metastasis from squamous cell carcinoma: indications and limits of different surgical approaches.

Fermi M, Liberale C, Molteni G Curr Opin Otolaryngol Head Neck Surg. 2025; 33(2):74-78.

PMID: 39782770 PMC: 11888840. DOI: 10.1097/MOO.0000000000001029.

References

Cengiz M, Ozyigit G, Yazici G, Dogan A, Yildiz F, Zorlu F . Salvage reirradiaton with stereotactic body radiotherapy for locally recurrent head-and-neck tumors. Int J Radiat Oncol Biol Phys. 2010; 81(1):104-9. DOI: 10.1016/j.ijrobp.2010.04.027. View

Harries V, McGill M, Tuttle R, Shaha A, Wong R, Shah J . Management of Retropharyngeal Lymph Node Metastases in Differentiated Thyroid Carcinoma. Thyroid. 2020; 30(5):688-695. PMC: 7232633. DOI: 10.1089/thy.2019.0359. View

Ferrari M, Schreiber A, Mattavelli D, Lombardi D, Rampinelli V, Doglietto F . Surgical anatomy of the parapharyngeal space: Multiperspective, quantification-based study. Head Neck. 2018; 41(3):642-656. DOI: 10.1002/hed.25378. View

Pilolli F, Giordano L, Galli A, Bussi M . Parapharyngeal space tumours: video-assisted minimally invasive transcervical approach. Acta Otorhinolaryngol Ital. 2016; 36(4):259-264. PMC: 5066460. DOI: 10.14639/0392-100X-709. View

Douglas W, Rigual N, Giese W, Bauer J, Wiseman S, Loree T . Advanced soft palate cancer: the clinical importance of the parapharyngeal space. Otolaryngol Head Neck Surg. 2005; 133(1):66-9. DOI: 10.1016/j.otohns.2005.03.007. View

Ohki H, Matsumoto M, Hasegawa M, Shimizu O, Mukae S, Amano Y . Unusual cyst-like lesions in the parapharyngeal space associated with recurrence of tongue carcinoma. J Oral Sci. 2006; 47(4):219-22. DOI: 10.2334/josnusd.47.219. View

Kuet M, Kasbekar A, Masterson L, Jani P . Management of tumors arising from the parapharyngeal space: A systematic review of 1,293 cases reported over 25 years. Laryngoscope. 2014; 125(6):1372-81. DOI: 10.1002/lary.25077. View

Doweck I, Robbins K, Mendenhall W, Hinerman R, Morris C, Amdur R . Neck level-specific nodal metastases in oropharyngeal cancer: is there a role for selective neck dissection after definitive radiation therapy?. Head Neck. 2003; 25(11):960-7. DOI: 10.1002/hed.10315. View

Wormald R, Sheahan P, Timon C . A case of head and neck cancer metastasizing to the axillary lymph nodes. Ear Nose Throat J. 2010; 89(8):E24-6. DOI: 10.1177/014556131008900807. View

10.

Carew J, SPIRO R, Singh B, Shah J . Treatment of recurrent pleomorphic adenomas of the parotid gland. Otolaryngol Head Neck Surg. 1999; 121(5):539-42. DOI: 10.1016/S0194-5998(99)70053-7. View

11.

Alessandro S, Magremanne M, Marbaix E, Reychler H, Mahy P . Axillary lymph node metastasis in second oropharyngeal cancer. J Stomatol Oral Maxillofac Surg. 2018; 120(2):160-163. DOI: 10.1016/j.jormas.2018.10.010. View

12.

Beswick D, Gooding W, Johnson J, Branstetter 4th B . Temporal patterns of head and neck squamous cell carcinoma recurrence with positron-emission tomography/computed tomography monitoring. Laryngoscope. 2012; 122(7):1512-7. PMC: 3677570. DOI: 10.1002/lary.23341. View

13.

Paderno A, Piazza C, Nicolai P . Recent advances in surgical management of parapharyngeal space tumors. Curr Opin Otolaryngol Head Neck Surg. 2015; 23(2):83-90. DOI: 10.1097/MOO.0000000000000134. View

14.

Lim Y, Koo B, Lee J, Lim J, Choi E . Distributions of cervical lymph node metastases in oropharyngeal carcinoma: therapeutic implications for the N0 neck. Laryngoscope. 2006; 116(7):1148-52. DOI: 10.1097/01.mlg.0000217543.40027.1d. View

15.

Leoncini E, Ricciardi W, Cadoni G, Arzani D, Petrelli L, Paludetti G . Adult height and head and neck cancer: a pooled analysis within the INHANCE Consortium. Eur J Epidemiol. 2013; 29(1):35-48. PMC: 4122122. DOI: 10.1007/s10654-013-9863-2. View

16.

Bradley P, Bradley P, Olsen K . Update on the management of parapharyngeal tumours. Curr Opin Otolaryngol Head Neck Surg. 2010; 19(2):92-8. DOI: 10.1097/MOO.0b013e328342b9b4. View

17.

Koenigsberg R, Vakil N, Noronha B . Undifferentiated metastatic carcinoma and myoepithelioma: two rare causes of hypervascular masses of the parapharyngeal space. Ear Nose Throat J. 2007; 86(7):402-5. View

18.

Shi X, Tao L, Li X, Wu H, Huang W, Chen X . Surgical management of primary parapharyngeal space tumors: a 10-year review. Acta Otolaryngol. 2016; 137(6):656-661. DOI: 10.1080/00016489.2016.1262551. View

19.

Schlieve T, Carlson E, Freeman M, Buckley R, Arnold J . The Double Mandibular Osteotomy for Vascular and Tumor Surgery of the Parapharyngeal Space. J Oral Maxillofac Surg. 2016; 75(5):1046-1061. DOI: 10.1016/j.joms.2016.11.003. View

20.

Magnes T, Wagner S, Kiem D, Weiss L, Rinnerthaler G, Greil R . Prognostic and Predictive Factors in Advanced Head and Neck Squamous Cell Carcinoma. Int J Mol Sci. 2021; 22(9). PMC: 8125786. DOI: 10.3390/ijms22094981. View