From the Guidelines
Treatment options for salivary gland cancer primarily include surgery, radiation therapy, and sometimes chemotherapy, depending on the cancer's stage, type, and location. Surgery is the mainstay treatment, involving removal of the affected gland and possibly surrounding tissues or lymph nodes. Common procedures include parotidectomy, submandibular gland excision, or more extensive resections for advanced cases. Radiation therapy often follows surgery to eliminate remaining cancer cells, typically delivered in daily sessions over 5-7 weeks. For advanced or recurrent cases, chemotherapy drugs like cisplatin, paclitaxel, or carboplatin may be used. Targeted therapies such as trastuzumab for HER2-positive tumors or larotrectinib for tumors with NTRK gene fusions are emerging options for specific molecular subtypes.
According to the ASCO guideline 1, comprehensive surgical resection and reconstruction of locoregional disease can be undertaken to improve or preserve quality of life in the context of metastatic disease. The guideline also recommends that all patients with recurrent salivary gland cancer should be evaluated in a multidisciplinary setting, whenever possible.
Some key points to consider in treatment planning include:
- Preservation of facial nerve function and quality of life
- The use of postoperative radiation therapy (RT) for patients with tumors with close margins or intermediate-grade tumors 1
- The consideration of adjuvant re-irradiation or intraoperative interventions such as intraoperative RT or brachytherapy at selected centers 1
- The use of systemic therapy, which has modest efficacy in metastatic salivary gland tumors, and should be considered in symptomatic patients or those with imminent organ damage due to metastatic burden 1
Regular follow-up appointments are essential to monitor for recurrence, with clinical follow-up with history and physical examination recommended on a regular basis, with decreasing frequency as time elapses from completion of treatment 1.
From the Research
Treatment Options for Salivary Gland Cancer
- Surgical resection is the first line treatment for salivary gland cancer (SGC) 2
- In cases of locally advanced disease, surgery is followed by adjuvant radiotherapy 2
- For inoperable and disseminated metastatic disease, systemic therapies including chemotherapy, targeted therapy, and immunotherapy are available 2
- Treatment algorithms for parotid, submandibular, sublingual and minor salivary gland cancer are provided in the ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline 3
Systemic Treatments for Recurrent or Metastatic Salivary Gland Cancer
- Systemic treatments can achieve prolonged progression-free and overall survival, while the overall prognosis remains poor 2
- The response rates are associated with specific receptor blockage, with trastuzumab plus chemotherapy, and bicalutamide being the most effective 4
- Anti-human epidermal growth factor receptor 2 therapy is more effective for salivary duct carcinoma (SDC), while chemotherapy is more effective for adenoid cyst carcinoma (ACC) 4
Salivary Gland Function After Surgery
- Submandibular gland excision can cause a decrease in unstimulated salivary volume 5
- The residual submandibular glands in the surgery group showed similar function to that of submandibular glands in the non-surgery group 5
- A compensatory salivary mechanism does not seem to be a possibility 5