Salivary gland tumor medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
The optimal therapy for salivary gland tumors depends on the stage at diagnosis. The mainstay of therapy for salivary gland tumors is surgery. External beam radiation therapy may be used following surgery, or when surgery is not possible or would cause significant complications. Chemotherapy is considered when radiation therapy or surgery is refused.
Medical Therapy
Surgery is usually done to remove the affected salivary gland. No other treatment is needed, if the tumor is benign. If the tumor is cancerous, radiation therapy or extensive surgery may be needed. Chemotherapy is used when the cancer has spread beyond the salivary glands. Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for salivary gland cancer are based on:
- Stage of the cancer
- Grade of the cancer
- Anatomical site of cancer
Treatment options for salivary cancer
- Surgery
- Radiation therapy
- External beam radiation therapy may be used following surgery, or when surgery is not possible or would cause significant complications.
- Chemotherapy
- The role of chemotherapy has not been firmly established, although there is some evidence that it may be effective in treating some salivary gland cancers. It is most often used during clinical trials. Sometimes chemotherapy is used when an individual chooses not to have radiation therapy or surgery. It may also be used for recurrent tumours or for tumors that do not respond to surgery and radiation therapy.
- Follow-up after treatment is finished
- It is important to have regular follow-up visits, especially in the first few years after treatment.
| Stage | Grade | Treatment |
|---|---|---|
| Stage I major salivary gland cancer | Low-grade tumors | Surgery alone |
| Postoperative radiation therapy should be considered when the resection margins are positive | ||
| 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 | ||
| 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 | ||
| Stage III 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 or surgery is refused or when tumors are recurrent or nonresponsive | ||
| High-grade tumors | Patients with 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 have been reported to be more effective than conventional x-ray therapy in the treatment of patients with inoperable, unresectable, or recurrent malignant salivary gland tumors | ||
| Stage IV major salivary gland cancer | Standard therapy for patients with tumors that have spread to distant sites is not curative | Fast neutron-beam radiation therapy or accelerated hyperfractionated photon-beam schedules have been reported to be more effective than conventional x-ray therapy in the treatment of patients with inoperable, unresectable, or recurrent malignant salivary gland tumors |
| Recurrent major salivary gland cancer | Fast neutron-beam radiation therapy is superior to conventional radiation therapy using x-rays and may be curative in selected patients with recurrent disease |