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Postoperative Management of Salivary Gland Tumors

  • Head and Neck Cancer (JL Geiger, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Salivary gland tumors represent a heterogeneous group of neoplasms characterized by varied histologies and disease outcomes. Initial treatment for the primary and gross nodal disease is usually surgery. Management of the clinically node-negative neck depends upon the risk of lymph nodal involvement. This is usually determined by the AJCC “T” stage and histology. Both surgery and radiation may be utilized to address the lymph nodes at risk. This is especially important for minor salivary gland tumors. Radiation plays an important role in the adjuvant management of salivary gland tumors by reducing the risk of locoregional recurrence. Certain histologies like adenoid cystic carcinoma have a predilection for neurotropic spread to the skull base. Radiation is particularly important in controlling disease at the skull base. The role of concurrent chemotherapy in the adjuvant treatment of salivary gland tumors is not established and remains an area of active research. Certain histologies like salivary duct carcinoma exhibit readily identifiable molecular targets amenable to targeted therapy. Finally, advanced testing of these tumors using next-generation sequencing can also potentially identify molecular targets amenable to therapy. While useful in the management of metastatic disease, the role of these therapies in the adjuvant setting remains unknown.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  Google Scholar 

  2. El-Naggar AK, Chan JKC, Takata T, Grandis JR, Slootweg PJ. The fourth edition of the head and neck World Health Organization blue book: editors' perspectives. Hum Pathol. 2017;66:10–2.

    Article  Google Scholar 

  3. Del Signore AG, Megwalu UC. The rising incidence of major salivary gland cancer in the United States. Ear, nose, & throat journal. 2017;96(3):E13–e6.

    Article  Google Scholar 

  4. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134–48.

    Article  Google Scholar 

  5. Spiro RH. Management of malignant tumors of the salivary glands. Oncology (Williston Park, NY). 1998;12(5):671–80 discussion 83.

    CAS  Google Scholar 

  6. Seethala RR, Stenman G. Update from the 4th Edition of the World Health Organization classification of head and neck tumours: tumors of the salivary gland. Head and neck pathology. 2017;11(1):55–67.

    Article  Google Scholar 

  7. Gilbert MR, Sharma A, Schmitt NC, Johnson JT, Ferris RL, Duvvuri U, et al. A 20-year review of 75 cases of salivary duct carcinoma. JAMA otolaryngology-- head & neck surgery. 2016;142(5):489–95.

    Article  Google Scholar 

  8. AJCC Cancer Staging Manual, Eighth Edition. 8th ed: springer; 2017.

    Google Scholar 

  9. Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-Heslinga RE, et al. The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys. 2005;61(1):103–11.

    Article  Google Scholar 

  10. Ferrell JK, Mace JC, Clayburgh D. Contemporary treatment patterns and outcomes of salivary gland carcinoma: a National Cancer Database review. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2019;276(4):1135–46.

    Google Scholar 

  11. Sood S, McGurk M, Vaz F. Management of salivary gland tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S142–s9.

    Article  CAS  Google Scholar 

  12. Ord RA, Ghazali N. Margin analysis: malignant salivary gland neoplasms of the head and neck. Oral and maxillofacial surgery clinics of North America. 2017;29(3):315–24.

    Article  Google Scholar 

  13. Garg M, Tudor-Green B, Bisase B. Current thinking in the management of adenoid cystic carcinoma of the head and neck. Br J Oral Maxillofac Surg. 2019;57(8):716–21.

    Article  Google Scholar 

  14. Ettl T, Gosau M, Brockhoff G, Schwarz-Furlan S, Agaimy A, Reichert TE, et al. Predictors of cervical lymph node metastasis in salivary gland cancer. Head & neck. 2014;36(4):517–23.

    Article  Google Scholar 

  15. Herman MP, Werning JW, Morris CG, Kirwan JM, Amdur RJ, Mendenhall WM. Elective neck management for high-grade salivary gland carcinoma. Am J Otolaryngol. 2013;34(3):205–8.

    Article  Google Scholar 

  16. RTOG-1008: Radiation therapy with or without chemotherapy in treating patients with high-risk malignant salivary gland tumors that have been removed by surgery. .

  17. •• Bakst RL, Glastonbury CM, Parvathaneni U, Katabi N, Hu KS, Yom SS. Perineural invasion and Perineural tumor spread in head and neck cancer. International journal of radiation oncology, biology, physics. 2019;103(5):1109–24 Important guideline discussing delineation of involved nerve pathways for neurotropic cancers of the head and neck.

    Article  Google Scholar 

  18. Hosni A, Huang SH, Goldstein D, Xu W, Chan B, Hansen A, et al. Outcomes and prognostic factors for major salivary gland carcinoma following postoperative radiotherapy. Oral Oncol. 2016;54:75–80.

    Article  Google Scholar 

  19. Cheraghlou S, Kuo P, Mehra S, Agogo GO, Bhatia A, Husain ZA, et al. Adjuvant therapy in major salivary gland cancers: analysis of 8580 patients in the National Cancer Database. Head & neck. 2018;40(7):1343–55.

    Article  Google Scholar 

  20. Aro K, Ho AS, Luu M, Kim S, Tighiouart M, Yoshida EJ, et al. Survival impact of adjuvant therapy in salivary gland cancers following resection and neck dissection. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2019;160(6):1048–57.

    Article  Google Scholar 

  21. Safdieh J, Givi B, Osborn V, Lederman A, Schwartz D, Schreiber D. Impact of adjuvant radiotherapy for malignant salivary gland tumors. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2017;157(6):988–94.

    Article  Google Scholar 

  22. Jang JY, Choi N, Ko YH, Chung MK, Son YI, Baek CH, et al. Treatment outcomes in metastatic and localized high-grade salivary gland cancer: high chance of cure with surgery and post-operative radiation in T1-2 N0 high-grade salivary gland cancer. BMC Cancer. 2018;18(1):672.

    Article  Google Scholar 

  23. Laccourreye H, Laccourreye O, Cauchois R, Jouffre V, Ménard M, Brasnu D. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients. Laryngoscope. 1994;104(12):1487–94.

    Article  CAS  Google Scholar 

  24. Myssiorek D, Ruah CB, Hybels RL. Recurrent pleomorphic adenomas of the parotid gland. Head & neck. 1990;12(4):332–6.

  25. •• Witt RL, Eisele DW, Morton RP, Nicolai P, Poorten VV, Zbären P. Etiology and management of recurrent parotid pleomorphic adenoma. The laryngoscope. 2015;125(4):888–93 A comprehensive review of pleomorphic adenoma management.

  26. Wallace AS, Morris CG, Kirwan JM, Werning JW, Mendenhall WM. Radiotherapy for pleomorphic adenoma. Am J Otolaryngol. 2013;34(1):36–40.

    Article  Google Scholar 

  27. Krolls SO, Boyers RC. Mixed tumors of salivary glands. Long-term follow-up. Cancer. 1972;30(1):276–81.

    Article  CAS  Google Scholar 

  28. Zbären P, Tschumi I, Nuyens M, Stauffer E. Recurrent pleomorphic adenoma of the parotid gland. Am J Surg. 2005;189(2):203–7.

    Article  Google Scholar 

  29. Phillips PP, Olsen KD. Recurrent pleomorphic adenoma of the parotid gland: report of 126 cases and a review of the literature. The Annals of otology, rhinology, and laryngology. 1995;104(2):100–4.

    Article  CAS  Google Scholar 

  30. • Kligerman MP, Jin M, Ayoub N, Megwalu UC. Comparison of Parotidectomy with observation for treatment of pleomorphic adenoma in adults. JAMA otolaryngology-- head & neck surgery. 2020; Interesting modeling study of observation for pleomorphic adenoma.

  31. Sandy SJ, Suppiah S, Robbins JR. Role of adjuvant radiotherapy for resected salivary ductal carcinoma. International journal of radiation oncology, biology, physics. 2017;99(2):E369.

    Article  Google Scholar 

  32. Jang S, Patel PN, Kimple RJ, McCulloch TM. Clinical outcomes and prognostic factors of adenoid cystic carcinoma of the head and neck. Anticancer Res. 2017;37(6):3045–52.

    PubMed  PubMed Central  Google Scholar 

  33. Ali S, Palmer FL, Katabi N, Lee N, Shah JP, Patel SG, et al. Long-term local control rates of patients with adenoid cystic carcinoma of the head and neck managed by surgery and postoperative radiation. Laryngoscope. 2017;127(10):2265–9.

    Article  CAS  Google Scholar 

  34. Lee A, Givi B, Osborn VW, Schwartz D, Schreiber D. Patterns of care and survival of adjuvant radiation for major salivary adenoid cystic carcinoma. The Laryngoscope. 2017.

  35. Chen AM, Garcia J, Granchi P, Bucci MK, Lee NY. Base of skull recurrences after treatment of salivary gland cancer with perineural invasion reduced by postoperative radiotherapy. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2009;34(6):539–45.

    Article  CAS  Google Scholar 

  36. Hay AJ, Migliacci J, Karassawa Zanoni D, McGill M, Patel S, Ganly I. Minor salivary gland tumors of the head and neck-Memorial Sloan Kettering experience: incidence and outcomes by site and histological type. Cancer. 2019;125(19):3354–66.

    Article  Google Scholar 

  37. • Baddour HM Jr, Fedewa SA, Chen AY. Five- and 10-year cause-specific survival rates in carcinoma of the minor salivary gland. JAMA otolaryngology-- head & neck surgery. 2016;142(1):67–73 Long-term outcomes for minor salivary gland cancers.

    Article  Google Scholar 

  38. Salgado LR, Spratt DE, Riaz N, Romesser PB, Wolden S, Rao S, et al. Radiation therapy in the treatment of minor salivary gland tumors. Am J Clin Oncol. 2014;37(5):492–7.

  39. Gillespie MB, Albergotti WG, Eisele DW. Recurrent salivary gland cancer. Curr Treat Options in Oncol. 2012;13(1):58–70.

    Article  Google Scholar 

  40. Pederson AW, Haraf DJ, Blair EA, Stenson KM, Witt ME, Vokes EE, Salama JK Chemoreirradiation for recurrent salivary gland malignancies. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2010;95(3):308–311.

  41. Jensen AD, Poulakis M, Nikoghosyan AV, Chaudhri N, Uhl M, Münter MW, Herfarth KK, Debus J Re-irradiation of adenoid cystic carcinoma: analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 2015;114(2):182–188.

  42. Vischioni B, Dhanireddy B, Severo C, Bonora M, Ronchi S, Vitolo V, Fiore MR, D'Ippolito E, Petrucci R, Barcellini A, Ciurlia E, Iannalfi A, Hasegawa A, Molinelli S, Mirandola A, Valvo F, Orecchia R Reirradiation of salivary gland tumors with carbon ion radiotherapy at CNAO. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2020;145:172–177.

  43. Karam SD, Snider JW, Wang H, Wooster M, Lominska C, Deeken J, et al. Reirradiation of recurrent salivary gland malignancies with fractionated stereotactic body radiation therapy. Journal of radiation oncology. 2012;1(2):147–53.

    Article  Google Scholar 

  44. Amini A, Waxweiler TV, Brower JV, Jones BL, McDermott JD, Raben D, et al. Association of adjuvant chemoradiotherapy vs radiotherapy alone with survival in patients with resected major salivary gland carcinoma: data from the National Cancer Data Base. JAMA otolaryngology-- head & neck surgery. 2016;142(11):1100–10.

    Article  Google Scholar 

  45. Gebhardt BJ, Ohr JP, Ferris RL, Duvvuri U, Kim S, Johnson JT, et al. Concurrent chemoradiotherapy in the adjuvant treatment of high-risk primary salivary gland malignancies. Am J Clin Oncol. 2018;41(9):888–93.

    Article  Google Scholar 

  46. Lassche G, van Boxtel W, Ligtenberg MJL, van Engen-van Grunsven ACH, van Herpen CML. Advances and challenges in precision medicine in salivary gland cancer. Cancer Treat Rev. 2019;80:101906.

    Article  CAS  Google Scholar 

  47. Keller G, Steinmann D, Quaas A, Grünwald V, Janssen S, Hussein K. New concepts of personalized therapy in salivary gland carcinomas. Oral Oncol. 2017;68:103–13.

    Article  CAS  Google Scholar 

  48. Takahashi H, Tada Y, Saotome T, Akazawa K, Ojiri H, Fushimi C, et al. Phase II trial of trastuzumab and docetaxel in patients with human epidermal growth factor receptor 2-positive salivary duct carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2019;37(2):125–34.

    Article  CAS  Google Scholar 

  49. Fushimi C, Tada Y, Takahashi H, Nagao T, Ojiri H, Masubuchi T, et al. A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma. Ann Oncol. 2018;29(4):979–84.

    Article  CAS  Google Scholar 

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Correspondence to Nikhil P. Joshi MD.

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James R Broughman declares that he has no conflict of interest.

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Joshi, N.P., Broughman, J.R. Postoperative Management of Salivary Gland Tumors. Curr. Treat. Options in Oncol. 22, 23 (2021). https://doi.org/10.1007/s11864-021-00820-9

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