What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?

After a nerve sparing parotidectomy, would you offer postoperative radiotherapy? If so, what volume and dose? Would it change your management if the patient is 30 years old and has Sjogren's syndrome?

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Radiation Oncology · Duke University Medical Center

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Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, typically a superficial parotidectomy. As surgery is not generally felt to be an optimal modality in this disease, in part due to the multifocality of MZL, I generally recommend RT despite an "excisional biopsy". If the patient had good pre-surgical imaging, with a single well-defined lesion, and an optimal surgical procedure was performed with negative margins, consideration could be made for observation. In a young patient with Sjogren's syndrome, a conservative approach as outlined above would clearly be justified.