title: Management of salivary gland tumors.
abstract: Surgery after proper imaging (MRI or CT scan) is the main stay of treatment for salivary gland tumors. Although excision margins should be ≥5 mm for malignant tumors in cases of parotid gland carcinoma, the facial nerve should be preserved whenever it is not infiltrated. Adjuvant external radiation is indicated for malignant tumors with high-risk features such as close (or invaded) margins, perineural speed, lymphatic and/or vascular invasion, lymph-node involvement and high-grade histology. A Phase II trial testing adjuvant concomitant cisplatin plus radiation therapy versus adjuvant radiation therapy alone after surgery is currently under investigation for high-risk salivary gland cancer. For inoperable cancers, photons combined with proton boost seem to be a valuable option. Even if protons or carbon ions are promising, access to the latter is limited for usual treatment. For recurrent and/or metastatic cancer, polychemotherapy (cisplatin based) gives a 25% response rate in adenoid cystic carcinoma and should be used when the disease is overtly in progression. Targeted therapies with anti-EGF receptor molecules, antiangiogenic agents and tyrosine kinase inhibitors are ongoing, but more trials are needed to establish their efficacy, as is the use of bortezomib followed by doxorubicin. The products of fusion oncogenes, which have a pathogenic role in some adenoid cystic carcinoma and mucoepidermoid carcinomas, are of interest as potential therapeutic targets.
authors.affiliation: Department of Surgery, Jules Bordet Institute, ULB, Brussels, Belgium. guy.andry@bordet.be
authors.forename: Guy
authors.initials: G
authors.lastname: Andry
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.forename: Laura D
authors.initials: LD
authors.lastname: Locati
authors.forename: Lisa
authors.initials: L
authors.lastname: Licitra
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D019468:Disease Management; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D020220:Facial Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods; D058990:Molecular Targeted Therapy / Q000379:methods / Q000639:trends; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000379:methods; D020379:Risk Adjustment; D012468:Salivary Gland Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D012469:Salivary Glands / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents