Management of Salivary Gland Malignancy
Key Points
Key Points
- Because salivary gland malignancies (SGMs) account for less than 5% of all head and neck cancers, there are limited clinical trial data to help guide therapy.
- Optimal treatment requires appropriate pathologic technique to differentiate among the wide spectrum of histologies and the variety of biological behaviors seen in SGMs.
Management
...agement...
...operative Evaluati...
...hould perform imaging (neck ultrasound,...
...rs should perform computed tomograp...
...ders should perform contrast-enhanced M...
...rform a CT/positron emission tomography from th...
...should perform a tissue biopsy (either fin...
...may perform core needle biopsy if fine need...
...ists should report risk of malignancy...
...gists may perform ancillary testing (immun...
...nd Therapeutic Surgical Procedures...
Surgeons should offer open surgical exc...
...ons may request intraoperative pathologic examin...
...rform partial superficial parotidectomy for app...
...the risk of intraparotid nodal metasta...
...perform facial nerve preservation in patients...
...uld perform resection of involved facial ne...
...ons should offer an elective neck treatm...
...or operative elective neck management of salivar...
...neck, surgeons may perform an ipsilateral neck...
...tting of resectable, recurrent locoregional...
...g of resectable, recurrent locoregional disease...
...nts undergoing revision surgery for re...
...otherapy...
...rative RT should be offered to all patients w...
...ve RT should be offered to patients wit...
...ost-operative RT may be offered to patients w...
...n post-operative cases, the high dose targ...
...of perineural invasion, the associated nerve(s)...
...dal coverage may be offered for T3–T4 pri...
...should be initiated within 8 weeks of surge...
...erapy, including proton, neutron, and carbon...
...ck irradiation may be offered in patient...
...uld be offered to patients with SGM who are n...
Systemic Th...
...of patients undergoing adjuvant radiotherapy, th...
...the setting of patients undergoing ra...
...salivary gland tumors expressing androgen rec...
...up Evaluations...
...cal follow-up with history and physic...
...st-treatment baseline imaging with...
...urveillance imaging of the primary site (cont...
...imaging of the primary site and the chest from yea...
...rm follow-up (beyond 5 years) with yearly...
...ecurrent/Metastatic Disea...
Patients presenting with metastati...
...he setting of adenoid cystic carcinoma and/or low...
...may be considered for initiation s...
...th adenoid cystic carcinoma who are can...
...atients with non-adenoid cystic saliv...
...emotherapy combinations may be offe...
...who are candidates for systemic therapy, check...
For patients with histologic tumor types wi...
...atients who may be potential candidates for sy...
...able 1. Risk of Malignancy (ROM) for Ea...
...Risk of High Grade Malignancy (ROHM)...