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
Manageme...
...perative Evaluat...
Providers should perform imaging (neck ultraso...
...roviders should perform computed tomog...
...ld perform contrast-enhanced MRI with...
...may perform a CT/positron emission...
...rs should perform a tissue biopsy (eithe...
...ders may perform core needle biopsy if fine needle...
...hould report risk of malignancy using a ri...
...athologists may perform ancillary testing (immun...
...tic and Therapeutic Surgical Procedures...
...ons should offer open surgical excision for hi...
...ns may request intraoperative pathologic examinat...
...rform partial superficial parotidectomy...
...se of the risk of intraparotid nodal m...
...ld perform facial nerve preservation...
...geons should perform resection of inv...
...offer an elective neck treatment over...
...ive elective neck management of salivar...
...N+ neck, surgeons may perform an ips...
...the setting of resectable, recurrent locoregional...
...the setting of resectable, recurrent locoregi...
...nts undergoing revision surgery for recu...
...diotherapy...
...tive RT should be offered to all pati...
...ve RT should be offered to patients with tu...
...ve RT may be offered to patients with t...
...ative cases, the high dose target should cover t...
...case of perineural invasion, the associated nerve...
...al coverage may be offered for T3–T...
...on should be initiated within 8 weeks of...
...therapy, including proton, neutron...
...e neck irradiation may be offered in...
...apy should be offered to patients wit...
...ystemic Therapy...
...ting of patients undergoing adjuva...
...setting of patients undergoing radioth...
...h salivary gland tumors expressing...
...-up Evaluation...
...follow-up with history and physical...
...aseline imaging with contrast CT or MRI (for...
...w-up surveillance imaging of the primary site...
Follow-up imaging of the primary site a...
...term follow-up (beyond 5 years) with ye...
...rent/Metastatic Disease...
...atients presenting with metastatic disease may be...
...the setting of adenoid cystic carcinoma and/or...
...may be considered for initiation systemic therapy...
...ents with adenoid cystic carcinoma who are candid...
...ients with non-adenoid cystic salivary glan...
...chemotherapy combinations may be off...
...who are candidates for systemic thera...
...ts with histologic tumor types with a h...
...ents who may be potential candidates for sy...
Table 1. Risk of Malignancy (ROM) fo...
...sk of High Grade Malignancy (ROHM) fo...