Salivary carcinomas are a rare group of biologically diverse neoplasms affecting the head and neck. The wide array of different histological entities and clinical presentations has historically limited attempts to establish well-defined treatment algorithms. In general, low-risk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach.
Methods
The relevant literature was reviewed, focusing on diagnostic and treatment algorithms for salivary malignancies.
Results
Salivary carcinomas with high-risk features require an aggressive treatment approach with complete surgical resection, neck dissection to appropriate cervical lymph-node basins, and postoperative radiotherapy.
Conclusions
The heterogeneity of salivary neoplasms represents a unique clinical challenge. Despite the multidisciplinary management paradigm detailed in this review, outcomes for advanced disease are unsatisfactory. Future progress will likely require the addition of novel systemic therapeutic strategies.
References
1.
GuzzoM., LocatiL.D., ProttF.J.Major and minor salivary gland tumors.Crit Rev Oncol Hematol.2010; 74(2): 134–148.
SeethalaR.R.An update on grading of salivary gland carcinomas.Head Neck Pathol.2009; 3(1): 69–77.
4.
BarnesL., EvesonJ.W., ReichartP.Pathology and Genetics of Head and Neck Tumours. In: World Health Organization. World Health Organization Classification of Tumours.Lyon, France: IARC Press; 2005: 210.
AdelsteinD.J., KoyfmanS.A., El-NaggarA.K.Biology and management of salivary gland cancers.Semin Radiat Oncol.2012; 22(3): 245–253.
7.
Vander PoortenV., BradleyP.J., TakesR.P.Diagnosis and management of parotid carcinoma with a special focus on recent advances in molecular biology.Head Neck.2012; 34(3): 429–440.
8.
WongD.S.Signs and symptoms of malignant parotid tumours: an objective assessment.J R Coll Surg Edinb.2001; 46(2): 91–95.
9.
Vander PoortenV., HuntJ., BradleyP.J.Recent trends in the management of minor salivary gland carcinoma.Head Neck.2014; 36(3): 444–455.
10.
ChenA.M., GarciaJ., GranchiP.J.Late recurrence from salivary gland cancer: when does “cure” mean cure?Cancer.2008; 112(2): 340–344.
11.
SpeightP.M., BarrettA.W.Prognostic factors in malignant tumours of the salivary glands.Br J Oral Maxillofac Surg.2009; 47(8): 587–593.
12.
PoortenV., HartA., VauterinT.Prognostic index for patients with parotid carcinoma: International external validation in a Belgian-German database.Cancer.2009; 115(3): 540–550.
13.
AliS., PalmerF.L., YuC.A predictive nomogram for recurrence of carcinoma of the major salivary glands.JAMA Otolaryngol Head Neck Surg.2013; 139(7): 698–705.
14.
ArmstrongJ.G., HarrisonL.B., SpiroR.H.Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy.Arch Otolaryngol Head Neck Surg.1990; 116(3): 290–293.
15.
SpiroR.H.Changing trends in the management of salivary tumors.Semin Surg Oncol.1995; 11(3): 240–245.
16.
TerhaardC.H.J., LubsenH., RaschC.R.N.The role of radiotherapy in the treatment of malignant salivary gland tumors.Int J Radiat Oncol Biol Phys.2005; 61(1): 103–111.
17.
BjørndalK., KrogdahlA., TherkildsenM.H.Salivary gland carcinoma in Denmark 1990-2005: Outcome and prognostic factors: results of the Danish Head and Neck Cancer Group (DAHANCA).Oral Oncol.2012; 48(2): 179–185.
18.
JeannonJ-P, CalmanF., GleesonM.Management of advanced parotid cancer. A systematic review.Eur J Surg Oncol.2009; 35(9): 908–915.
19.
ChristeA., WaldherrC., HallettR.MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease.Am J Neuroradiol.2011; 32(7): 1202–1207.
20.
de RuJ.A., van LeeuwenM.S., van BenthemP.P.G.Do magnetic resonance imaging and ultrasound add anything to the preoperative work-up of parotid gland tumors?J Oral Maxillofac Surg.2007; 65(5): 945–952.
21.
DouvilleN.J., BradfordC.R.Comparison of ultrasound-guided core biopsy versus fine-needle aspiration biopsy in the evaluation of salivary gland lesions.Head Neck.2013; 35(11): 1657–1661.
22.
AlphsH.H., EiseleD.W., WestraW.H.The role of fine needle aspiration in the evaluation of parotid masses.Curr Opin Otolaryngol Head Neck Surg.2006; 14(2): 62–66.
23.
KimB.Y., HyeonJ., RyuG.Diagnostic accuracy of fine needle aspiration cytology for high-grade salivary gland tumors.Ann Surg Oncol.2013; 20(7): 2380–2387.
24.
TryggvasonG., GaileyM.P., HulsteinS.L.Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically.Laryngoscope.2013; 123(1): 158–163.
25.
MendenhallW.M., MorrisC.G., AmdurR.J.Radiotherapy alone or combined with surgery for salivary gland carcinoma.Cancer.2005; 103(12): 2544–2550.
26.
ChenA.M., GranchiP.J., GarciaJ.Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: Implications for adjuvant therapy.Int J Radiat Oncol Biol Phys.2007; 67(4): 982–987.
27.
SpiroJ.D., SpiroR.H.Cancer of the parotid gland: role of 7th nerve preservation.World J Surg.2003; 27(7): 863–867.
28.
AmitM., BinenbaumY., Trejo-LeiderL.International collaborative validation of intraneural invasion as a prognostic marker in adenoid cystic carcinoma of the head and neck.Head Neck.2014; 55(7): 691–696.
29.
Coca-PelazA., RodrigoJ.P., BradleyP.J.Adenoid cystic carcinoma of the head and neck - an update.Oral Oncol.2015; 51(7): 652–661.
30.
TarsitanoA., PizzigalloA., GessaroliM.Intraoperative biopsy of the major cranial nerves in the surgical strategy for adenoid cystic carcinoma close to the skull base.Oral Surg Oral Med Oral Pathol Oral Radiol.2012; 113(2): 214–221.
31.
ChangY., YoungS., KimK.Conservative parotidectomy for the treatment of parotid cancers.Oral Oncol.2005; 41(10): 1021–1027.
32.
BellR.B., DierksE.J., HomerL.Management and outcome of patients with malignant salivary gland tumors.J Oral Maxillofac Surg.2005; 63(7): 917–928.
33.
VillanuevaN.L., de AlmeidaJ.R., SikoraA.G.Transoral robotic surgery for the management of oropharyngeal minor salivary gland tumors.Head Neck.2014; 36(1): 28–33.
34.
MooreB.A., BurkeyB.B., NettervilleJ.L.Surgical management of minor salivary gland neoplasms of the palate.Ochsner J.2008; 8(4): 172–180.
35.
ChungM.P., TangC., ChanC.Radiotherapy for nonadenoid cystic carcinomas of major salivary glands.Am J Otolaryngol Neck Med Surg.2013; 34(5): 425–430.
36.
FeinsteinT.M., LaiS.Y., LenznerD.Prognostic factors in patients with high-risk locally advanced salivary gland cancers treated with surgery and postoperative radiotherapy.Head Neck.2011; 33(3): 318–323.
37.
HocwaldE., KorkmazH., YooG.H.Prognostic factors in major salivary gland cancer.Laryngoscope.2001; 111(8): 1434–1439.
38.
ZbärenP., NuyensM., CaversaccioM.Postoperative radiation therapy for T1 and T2 primary parotid carcinoma: is it useful?Otolaryngol Head Neck Surg.2006; 145(1): 140–143.
AliS., PalmerF.L., DiLorenzoM.Treatment of the neck in carcinoma of the parotid gland.Ann Surg Oncol.2014; 21(9): 3042–3048.
41.
LimC.M., GilbertM., JohnsonJ.T.Is level V neck dissection necessary in primary parotid cancer?Laryngoscope.2015; 125(1): 118–121.
42.
YooS-H, RohJ-L, KimS-O. Patterns and treatment of neck metastases in patients with salivary gland cancers.J Surg Oncol.2015; 111(8): 1000–1006.
43.
NobisC-P, RohlederN.H., WolffK-D. Head and neck salivary gland carcinomas–elective neck dissection, yes or no?J Oral Maxillofac Surg.2014; 72(1): 205–210.
44.
ChenA.M., GarciaJ., LeeN.Y.Patterns of nodal relapse after surgery and postoperative radiation therapy for carcinomas of the major and minor salivary glands: what is the role of elective neck irradiation?Int J Radiat Oncol Biol Phys.2007; 67(4): 988–994.
45.
HermanM.P., WerningJ.W., MorrisC.G.Elective neck management for high-grade salivary gland carcinoma.Am J Otolaryngol - Head Neck Med Surg.2013; 34(3): 205–208.
46.
LauV.H., AouadR., FarwellD.G.Patterns of nodal involvement for clinically NO salivary gland carcinoma: refining the role of elective neck irradiation.Head Neck.2014; 36(10): 1435–1439.
47.
DouglasJ.G., KohW., Austin-SeymourM.Treatment of salivary gland neoplasms with fast neutron radiotherapy.Arch Otolaryngol Head Neck Surg.2003; 129(9): 944–948.
48.
Jereczek-FossaB.A., KrengliM., OrecchiaR.Particle beam radiotherapy for head and neck tumors: radiobiological basis and clinical experience.Head Neck.2006; 28(8): 750–760.
49.
LaramoreG.E., KrallJ.M., GriffinT.W.Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial.Int J Radiat Oncol Biol Phys.1993; 27(2): 235–240.
50.
HuberP.E., DebusJ., LatzD.Neutron beam radiation therapy: an overview of treatment and oral complications when treating salivary gland malignancies.J Oral Maxillofac Surg.2003; 3016(2): 377–382.
51.
ChenA.M., LauV.H., FarwellD.G.Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: clinicopathologic correlates of outcome.Laryngoscope.2013; 123(12): 3049–3055.
52.
StodulskiD., MikaszewskiB., StankiewiczC.Are all prognostic factors in parotid gland carcinoma well recognized?Eur Arch Oto-Rhino-Laryngology.2012; 269(3): 1019–1025.
53.
RenehanA.G., GleaveE.N., SlevinN.J.Clinico-pathological and treatment-related factors influencing survival in parotid cancer.Br J Cancer.1999; 80(8): 1296–1300.
54.
BhattacharyyaN., FriedM.P.Determinants of survival in parotid gland carcinoma: a population-based study.Am J Otolaryngol Head Neck Med Surg.2005; 26(1): 39–44.
55.
CarrilloJ.F., VázquezR., Ramírez-OrtegaM.C.Multivariate prediction of the probability of recurrence in patients with carcinoma of the parotid gland.Cancer.2007; 109(10): 2043–2051.
56.
TakahamaA., Sanabriaá, BenevidesG.M.Comparison of two prognostic scores for patients with parotid carcinoma.Head Neck.2009; 31(9): 1188–1195.
57.
Van Der SchroeffM.P., TerhaardC.H.J., WieringaM.H.Cytology and histology have limited added value in prognostic models for salivary gland carcinomas.Oral Oncol.2010; 46(9): 662–666.
58.
MahmoodU., KoshyM., GoloubevaO.Adjuvant radiation therapy for high-grade and/or locally advanced major salivary gland tumors.Arch Otolaryngol Head Neck Surg.2011; 137(10): 1025–1030.
59.
AliS., SarhanM., PalmerF.L.Cause-specific mortality in patients with mucoepidermoid carcinoma of the major salivary glands.Ann Surg Oncol.2013; 20(7): 2396–2404.
60.
RizkS., RobertA., VandenhooftA.Activity of chemotherapy in the palliative treatment of salivary gland tumors: review of the literature.Eur Arch Oto-Rhino-Laryngology.2007; 264(6): 587–594.
61.
LaghaA., ChraietN., AyadiM.Systemic therapy in the management of metastatic or advanced salivary gland cancers.Head Neck Oncol.2012; 4(10): 19.
62.
DebaereD., Vander PoortenV., NuytsS.Cyclophosphamide, doxorubicin, and cisplatin in advanced salivary gland cancer.B-ENT.2011; 7(1): 1–6.
63.
Vander PoortenV., MeulemansJ., DelaereP.Molecular markers and chemotherapy for advanced salivary cancer.Curr Otorhinolaryngol Rep.2014: 85–96.
64.
LicitraL., CavinaR., GrandiC.Cisplatin, doxorubicin and cyclophosphamide in advanced salivary gland carcinoma.Ann Oncol.1996; 7(6): 640–642.
65.
TanvetyanonT., QinD., PadhyaT.Outcomes of postoperative concurrent chemoradiotherapy for locally advanced major salivary gland carcinoma.Arch Otolaryngol Head Neck Surg.2009; 135(7): 687–692.
66.
CerdaT., ShanX., VignotS.REFCOR. A rationale for chemoradiation (vs radiotherapy) in salivary gland cancers ?Crit Rev Oncol / Hematol.2014; 91(2): 142–158.
67.
PedersonA.W., SalamaJ.K., HarafD.J.Adjuvant chemoradiotherapy for locoregionally advanced and high-risk salivary gland malignancies.Head Neck Oncol.2011; 3(1): 31.
