Page 57 - New epidemiological and PSMA-expression based paradigms in salivary gland tumors

Natural history of recurrent pleomorphic adenoma
In conclusion, the traditional perceived risk of MT after RPA (up to 24%), which has been at the center of the clinical management of RPA, has now been more clearly defined and quantified as relatively low by the pooled Danish/Dutch national data [1,2]. This new picture of RPA raises the question whether the current low threshold for repeated surgery is optimal, especially with the risk of facial nerve injury in mind. Informed discussion with the patient can now be based on more scientifically valid information on risk of MT. The population at risk of RPA are young adults and the majority are females in the formative years of their life. Facial disfigurement with or without facial nerve palsy at this juncture in one’s life can transform life opportunities. In contrast, nodules of RPA can be monitored easily, inexpensively and accurately by ultrasound examination and suspicious nodules can be sampled by FNAC [40]. It is acknowledged that it is unlikely that a young adult with RPA can avoid further surgical treatment, but if disfiguring surgery and possibly RT can be delayed a decade or more by judicious surveillance with patient collaboration and “lump picking”, it may have less impact on life opportunities and the risk of radiation-induced complications. This more conservative treatment strategy can be adopted in other patient categories as well, based on well informed patient preferences as part of a personalized treatment plan.
Supplemental information can be accessed via a link to the journal website.
https://onlinelibrary.wiley.com/doi/10.1002/hed.26137
Acknowledgements
The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry.
The authors also thank the Dutch and Danish pathologists and PALGA foundation. It is with deep regret that we have to report that our friend and esteemed colleague Simon Andreasen died on the 28th of February before seeing this article in print. He worked on the publication through his illness and without us being aware of the severity of his condition. Our deep condolence goes to his young wife and family. Medicine has been robbed of a very able clinical scientist honorable clinician.
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