Advanced soft palate cancer: The clinical importance of the parapharyngeal space

OBJECTIVE: To identify the incidence of parapharyngeal space (PPS) recurrences and how they impact survival in advanced-stage soft-palate carcinoma patients. STUDY DESIGN AND SETTING: One hundred thirty-seven patients' charts were reviewed from 1971 to 1996. Inclusion criteria were patients who received a per-oral resection, discontinuous neck dissection, and postoperative adjuvant radiation therapy; 15 patients met criteria for inclusion. The incidence of PPS recurrences, regional failure, and survival were endpoints that were analyzed. RESULTS: There were no local failures in our study. Regional failures excluding the PPS (levels I-V) were 27%, and 40% occurred within the PPS. Cervical adenopathy was associated with 83% of the PPS recurrences. Median survival for PPS recurrences was 26 months, compared with 67 months for levels I-V recurrences (n = ns). CONCLUSIONS: The incidence of PPS recurrences is substantial in advanced-stage soft-palate cancer. PPS recurrences negatively impact survival; without effective salvage techniques for these recurrences or effective adjuvant therapy, poor patient outcomes can be expected.