From the Guidelines
Surgery is the primary treatment for salivary gland cancer, and it should be combined with radiation therapy for high-grade tumors or those with close margins, as recommended by the most recent guidelines 1. The treatment of salivary gland cancer depends on the stage, type, and location of the tumor.
- For early-stage tumors, surgery alone may be sufficient, while for advanced tumors, a combination of surgery, radiation therapy, and chemotherapy may be necessary.
- Radiation therapy is often used to eliminate remaining cancer cells after surgery, and it can be delivered at doses of 60-70 Gy over 6-7 weeks.
- Chemotherapy agents like cisplatin, paclitaxel, or carboplatin may be used for advanced or recurrent cases.
- Targeted therapies such as trastuzumab for HER2-positive tumors or pembrolizumab for certain advanced cases are emerging options.
- The treatment selection depends on factors including tumor histology, stage, and the patient's overall health.
- Early detection significantly improves outcomes, as salivary gland cancers can be aggressive and may spread to nearby structures or metastasize to distant organs if left untreated, as noted in the guidelines 1 and 1.
- For recurrent salivary gland cancer, revision surgical resection to clear margins is the primary treatment, and it should be carefully planned with thorough shared patient decision making regarding therapeutic intent, side effects, and potential complications, as recommended by the guidelines 1.
- The use of postoperative radiation therapy (RT) may be offered to patients with tumors with close margins or intermediate-grade tumors, as suggested by the guidelines 1.
- The management of salivary gland malignancy should be based on a multidisciplinary approach, and patients should be evaluated in a multidisciplinary setting, whenever possible, to determine the best course of treatment, as recommended by the guidelines 1 and 1.
From the Research
Treatment Options for Salivary Gland Cancer
The treatment options for salivary gland cancer vary depending on the stage and type of cancer.
- For early-stage salivary gland cancer, surgical resection is the primary treatment option 2.
- For locally advanced disease, surgery is often followed by adjuvant radiotherapy 2, 3.
- In cases where the cancer is inoperable or has disseminated metastases, systemic therapies such as chemotherapy, targeted therapy, and immunotherapy may be used 2, 4.
Treatment Recommendations for Early-Stage Salivary Gland Cancer
For early-stage salivary gland cancer, the following treatment recommendations can be made:
- Surgical resection is the primary treatment option, with the goal of achieving a cancer-free surgical margin 5, 3.
- Postoperative radiation therapy may be recommended for patients with high-risk features, such as perineural invasion, lymphovascular invasion, or close surgical margins 5, 3.
- For patients with low-grade salivary gland cancer, surgery alone may be sufficient, with excellent oncological outcomes 5.
Treatment Recommendations for Advanced Salivary Gland Cancer
For advanced salivary gland cancer, the following treatment recommendations can be made:
- Systemic therapies such as chemotherapy, targeted therapy, and immunotherapy may be used to achieve prolonged progression-free and overall survival 2, 4.
- Platinum-based regimens are commonly used, with other regimens depending on the histology of the tumor 4.
- Postoperative radiation therapy may be recommended for patients with high-risk features, such as advanced T stage or N stage 3, 6.
Prognostic Factors and Outcomes
The prognosis for salivary gland cancer depends on various factors, including:
- Tumor stage, with more advanced stages associated with worse outcomes 5, 3, 6.
- Histology, with certain types of tumors having a better prognosis than others 4, 6.
- Presence of perineural invasion, lymphovascular invasion, or close surgical margins, which can increase the risk of recurrence 5, 3.
- Overall survival rates vary depending on the stage and type of cancer, with 5-year survival rates ranging from 63% to 96% 3, 6.