Mucoepidermoid carcinoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2] , Maria Fernanda Villarreal, M.D. [3]
Overview
There is no medical treatment for mucoepidermoid carcinoma. Radiotherapy can be neoadjuvant treatment in some lesions (dependent on the tumor stage and size).[1]
Medical Therapy
There is no medical treatment for mucoepidermoid carcinoma. Radiotherapy can be neoadjuvant treatment in some lesions (dependent on the tumor stage and size).[1] In general, salivary gland neoplasms respond poorly to chemotherapy, and adjuvant chemotherapy is currently indicated only for palliation. Doxorubicin- and platinum-based agents are most commonly used with the platinum-based agents that induce apoptosis versus the doxorubicin-based drugs that promote cell arrest. Platinum-based agents, in combination with mitoxantrone or vinorelbine, are also effective in controlling recurrent salivary gland malignancy. A new form of 5-fluorouracil called fluoropyrimidine that has increased activity against malignant cells and while having fewer gastrointestinal side effects has shown to be efficacious against malignant salivary cancers and to potentiate the effects of radiotherapy by increasing apoptosis.
Newer trials with antimicrotubule agents with and without concomitant radiotherapy have shown efficacy. Using a platinum-based agent, cisplatin, and an antimicrotubule drug, docetaxel, with radiation shows some promise in advanced carcinomas of the salivary gland. Using paclitaxel (Taxol), another antimicrotubule drug, alone has had moderate activity against mucoepidermoid tumors and adenocarcinomas but no effect adenoid cystic carcinoma.[2]
Various targeted biologic agents such as trastuzumab, imatinib, and cetuximab are currently being investigated.
Radiotherapy
Radiotherapy is rarely the definitive treatment modality for salivary gland neoplasms, being used alone usually for tumors that are considered nonresectable. More studies have quantified the use of radiotherapy in the postoperative setting. The use of radiation in T1 and T2 parotid gland tumors found that 5-year disease-free survival increased from 70% to 92% with postoperative radiation. A second study investigated postresection radiotherapy for carcinoma ex pleomorphic adenoma and found a 26% improvement in 5-year local control (from 49% to 75%). Nonetheless, prospective randomized controlled studies are needed to confirm the usefulness of postoperative radiotherapy.
Newer techniques for postoperative radiation in salivary gland malignancies have been proven effective. These include gamma-knife stereotactic radiosurgery and brachytherapy (radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues). Iodine-125 seeds have been found to be an effective treatment for incompletely resected or unfavorable histological salivary gland malignancies of the hard and soft palate. Gamma-knife treatments after neutron therapy are useful if the local failure risk is still high.
Recent reports have shown that neutron-based radiation therapy may be more effective than photon-based radiation therapy for the treatment of malignant salivary gland neoplasms with gross disease and provides excellent local and regional control of microscopic disease. This therapy has been proven to have good local control and survival rates in patients with grossly recurrent pleomorphic adenomas that cannot be resected. In adenoid cystic carcinoma that is recurrent, is advanced, or has been resected with positive margins, neutron therapy can provide better local control than photon-based therapies, but it does not improve survival because of the excessive number of metastases that prevail in advanced stages. Doses as high as of 60 Gy (1 Gy=100 rad) were needed in stage 3 or 4 tumors that have invaded bone, nerves, or lymph nodes. If the tumor is completely unresectable, doses as high as 66 Gy are needed.[3]
References
- ↑ 1.0 1.1 Evans HL (1984). "Mucoepidermoid carcinoma of salivary glands: a study of 69 cases with special attention to histologic grading". Am. J. Clin. Pathol. 81 (6): 696–701. PMID 6731349.
- ↑ Stenner M, Klussmann JP (March 2009). "Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved". Eur Arch Otorhinolaryngol. 266 (3): 333–41. doi:10.1007/s00405-008-0882-7. PMID 19052760.
- ↑ Park G, Lee SW (December 2018). "Postoperative radiotherapy for mucoepidermoid carcinoma of the major salivary glands: long-term results of a single-institution experience". Radiat Oncol J. 36 (4): 317–324. doi:10.3857/roj.2018.00409. PMID 30630270.