Adjuvant Management of Advanced High-Risk Salivary Gland Malignancy
Salivary gland malignancies (SGM) are a rare group of head and neck cancers. Surgical resection is the primary treatment modality but in patients with high risk features (close or positive margins, advanced T stage, high grade histology, nodal metastasis, bone invasion, perineural invasion, and extracapsular spread) there is debate on whether adjuvant radiation therapy (RT), systemic therapy or both might improve locoregional control and improve survival. We reviewed the literature surrounding the use of adjuvant therapy for the treatment of SGM with high risk features in patients who had already undergone surgical resection. Evidence based on retrospective series and database studies suggest that it is reasonable to offer adjuvant RT to these patients as it might improve locoregional control and offer possible survival benefit (quality of evidence: weak, strength of recommendation: weak). Regarding the use of adjuvant systemic therapy, evidence based on retrospective series and database studies suggest that it should not be offered to these patients as it has shown no benefit to locoregional control or survival (quality of evidence: weak, strength of recommendation: weak). Finally, we briefly discuss a clinical trial currently under way that should add to our understanding of the survival and toxicity outcomes of adding systemic therapy to radiation in this patient population.
KeywordsSalivary gland malignancy Salivary gland neoplasm Chemotherapy Radiation therapy Adjuvant therapy Systemic therapy High risk
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