Thanks for writing in.
I understand your concern.
Treatment of recurrent cases of pleomorphic adenoma is a dilemma. As of now, for your husband, radiotherapy may be given, given that he has had multiple recurrences. This is done in many cases where further surgical treatment of recurrent disease is not possible. If you have a recent MRI imaging, you may share some images here. By now the tumor should be involving the skin or subcutaneous fat, sitting on the facial nerve. I would like to know how is his facial nerve function? Complete tumor removal with a cuff of tissue in this case may require sacrifice of the overlying skin (with a skin flap repair), facial nerve or some of it's branches.
The full dose of Radiotherapy can be given only once in a lifetime and hence a low dose has been advised. However, it also carries a risk of malignant transformation that increases over time. Hence I would recommend a full dose.
You should also explore Image Guided Radiotherapy (IGRT), Gamma Knife and Cyber Knife.
The risk of carcinoma ex pleomorphic adenoma or worse, an adenocarcinoma is high after multiple surgeries and often discovered later on histopathology of the excised specimen.
Hope that this information helps and hope that you will get better soon.
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Dr. Sumit Bhatti
Thank you, Dr. Bhatti. His facial nerve function is good now. During surgery #2, they did a complete parotidectomy and nerve dissection but surgery #3 was a superficial last month. The surgeon says that this time, the tumors (observed as one on the CT scan, but turned out to be multiple) were in a "good place", and are not sitting on the nerve. Nevertheless, he seems to think that those tumors will come back in generally the same spot so I am not sure if that means future facial nerve function would be compromised, but I seem to think that with a 4th surgery that we're "inviting trouble" and I don't understand the involvement of other nerves that could cause the headaches and other neck pain. We will certainly ask the radiation oncologist about the Cyber, gamma radiation methods as possibilities. We don't want to let these tumors and tissue grow into adenocarcinoma. No beuno.
Most sincere thanks,
Sunflower1975 in Northern VA