Salivary gland tumor medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Stage	Grade	Treatment
Stage I major salivary gland cancer	Low grade tumor	Surgery alone. Postoperative radiation therapy should be considered when the resection margins are positive.
	High grade tumor	Localized high-grade salivary gland tumors that are confined to the gland in which they arise may be cured by radical surgery alone Postoperative radiation therapy may improve local control and increase survival rates for patients with high-grade tumors, positive surgical margins, or perineural invasion
Stage II major salivary gland cancer	Low grade tumors	Surgery alone or with postoperative radiation therapy, if indicated, is appropriate Chemotherapy should be considered in special circumstances, such as when radiation therapy or surgery is refused
	High grade tumors	Localized high-grade salivary gland tumors that are confined to the gland in which they arise may be cured by radical surgery alone Postoperative radiation therapy may improve local control and increase survival rates for patients with high-grade tumors, positive surgical margins, or perineural invasion Fast neutron-beam radiation therapy or accelerated hyperfractionated photon-beam schedules reportedly are more effective than conventional x-ray therapy in the treatment of patients with inoperable, unresectable, or recurrent malignant salivary gland tumors
	Second	External beam radiation therapy
	Third	Periocular carboplatin therapy
	Fourth	Enucleation
Without vitreous seeding
Tumor >2 disc diameters in size	First	Systemic or intra-arterial chemotherapy
	Plus	Concurrent laser ablation or cryotherapy
	Second	External beam radiation therapy
	Third	Periocular carboplatin therapy
	Fourth	Enucleation
Tumor 2 disc diameters or less in size	First	Focal laser ablation alone
	Second	Systemic or intra-arterial chemotherapy
	Plus	Concurrent laser ablation or cryotherapy
	Third	External beam radiation therapy
	Fourth	Periocular carboplatin therapy
	Fifth	Enucleation
Metastatic disease	First	Multimodal therapy
Recurrence
Post globe-salvaging therapy	First	Brachytherapy
Post enucleation	First	External beam radiation therapy
	Adjunct	Systemic chemotherapy

If the cancer is high-grade, treatment may include the following for all the 4 stages of tumor:

• Radiation therapy may be given after surgery.
• Fast neutron radiation therapy.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of radiation therapy and/or radiosensitizers.
• A clinical trial of chemotherapy.

For stages I, II and III surgery is the main stay of treatment.

Radiation Therapy

Fast neutron therapy has been used successfully to treat salivary gland tumors, and has shown to be significantly more effective than photons in studies treating unresectable salivary gland tumors.