Update and perspectives on non-surgical treatment of salivary gland malignancies.
Surgery is the treatment of choice for major and minor salivary gland malignancies. Herein, the role of radiation and medical treatment in the multidisciplinary management of salivary gland tumours is discussed. Neutron irradiation and hyperfractionated external beam mega voltage irradiation improve local control. Combination of three dimensional conformal radiotherapy and intensive-modulated radiation therapy provide better local tumour delineation, better field design to encompass the tumour allowing dose escalation to target while sparing the surrounding normal tissue. Cisplatin-based chemotherapy provides a response rate > or = 45%, in a palliative setting. Concomitant chemo-radiotherapy could improve local control. Recent studies evaluated the expression of molecular targets in salivary gland carcinomas (c-kit = 53-90%, EGFR = 25-85%, c-erb-B2 = 11-58%, p53 = 11-67%, H ras = 18%); these targets are very important since new targeted drugs are now available. Anti-androgen therapy might have a role in the management of patients with ductal carcinoma. These new targeted drugs could be integrated with chemotherapy and radiotherapy in the treatment of locally advanced/metastatic salivary gland malignancies.
Airoldi
M
M
Department of Medical Oncology, S. Giovanni Antica Sede Hospital, Turin, Italy. mario.airoldi@jumpy.it
Cortesina
G
G
Giordano
C
C
Pedani
F
F
Cavalot
A
A
Marcato
P
P
Beatrice
F
F
Bumma
C
C
D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D011882:Radiotherapy, High-Energy; D012468:Salivary Gland Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D013997:Time Factors
D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D002945:Cisplatin