Management of Salivary Gland Cancer

  • Laura D. Locati
  • Marco Guzzo
  • Patrizia Olmi
  • Lisa Licitra


Carcinomas of the salivary glands are uncommon representing only 2–6.5% of all head and neck cancer and less than 1% of all cancers. About 85% of salivary gland tumors arise in the parotid glands and approximately 75% of these are benign while about 75% of tumors arising from minor salivary glands are malignant. The latest WHO’s histological classification (2005) includes both benign and more than 20 different types of malignant tumors. The morphological diversity between different tumor types and sometimes within the same tumor mass along with the relative rarity of some tumors can make diagnosis difficult and needs a skilled pathologist.The American Joint Cancer Committee’s (AJCC) tumor, node, metastasis (TNM) has defined a staging system for major salivary gland malignancies. Cancer from minor salivary gland scattered throughout all the head and neck mucosa are staged according to the AJCC system for the more common squamocellular cancer arising in the same location.Surgery of primary tumor, whenever possible, is the treatment of choice both for major and minor salivary gland tumors. A clinically positive neck requires a neck dissection along with the resection of primary tumor. The treatment of N0 neck in patients with malignant salivary gland tumors is a matter of debate. High-grade tumors, high primary T stage, and the presence of facial paralysis are associated with high incidence of neck node metastasis.Adjuvant radiotherapy improves locoregional control following surgery. Despite the absence of randomized trials, postoperative radiotherapy is recommended in high-grade tumors, advanced stage tumor (T4), “close” (≤5 mm) or microscopically positive surgical margins, and neck node metastases.Radiotherapy can be the best treatment option in case of “technically” unresectable or “medically” inoperable tumor. The use of concomitant chemoradiotherapy in salivary gland cancer is still investigational.Chemotherapy is delivered in case of relapsed and/or metastatic disease with a palliative aim. There is neither standard chemotherapy regimen nor data on whether polychemotherapy is more active than monochemotherapy. Although, a cisplatinum-based chemotherapy for four to six courses is considered the best choice.Targeted therapies, as tyrosine-kinase inhibitor or monoclonal antibodies, are under evaluation. Phase II studies are ongoing.


Salivary gland cancer Surgery Radiotherapy Chemotherapy Target therapy 



The authors thank Maria Teresa Giannelli for her help in editing this chapter.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Laura D. Locati
  • Marco Guzzo
  • Patrizia Olmi
  • Lisa Licitra
    • 1
  1. 1.Department of Medical OncologyIRCCS Fondazione Istituto Nazionale Tumori Milan ItalyMilanItaly

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