Management of salivary gland carcinomas - a review

Abstract

Salivary gland carcinomas are a heterogeneous group of tumors with many histological subtypes which occur in both major and minor salivary glands. However, they have a relatively low of incidence. Their rarity limits study size and the ability to perform phase III trials. Therefore, to date, the entire management is usually varied. Certain published studies have paid more attention to the systemic therapy in the management of metastatic or locally recurrent salivary gland cancer, while little effort has been made to study the entire management for this lesions. Although results of treatment for patients with salivary gland carcinoma have improved in recent years, the treatment of salivary gland cancers is still not standardized. And some patients who haven’t received optimal treatment strategies had a reduced survival. In this review, the topics covered include surgery and radiotherapy, selective neck dissection, chemotherapy, and targeted therapy, which aimed to summarize the optimal management approaches and to develop recommendations for managing this lesions. For these rare cancers, there is also a need for a determined, coordinated effort to conduct high-quality clinical trials.

The Milan system for reporting salivary gland cytopathology: A study of inter‐observer reproducibility

“…This system formalizes diagnostic categories and relates them to malignancy risk, recommended clinical therapy and follow‐up . Recommendations for management for salivary gland carcinomas have been made but a system combining diagnostic categories with clinical management recommendations has not been previously published. For a diagnostic categorization scheme to be clinically relevant it requires that the system be diagnostically accurate as well as showing good consistency in categorization of specimens between observers.…”

Application of Sentinel Node Biopsy to Nonoral Head and Neck Cancer

“…Because of the diversity and scarcity of salivary tumors, there is a deficit of high-level evidence regarding treatment, a fact recognized by recently published UK management guidelines. 10 The rate of occult metastases in salivary malignancy is 10-30% [11][12][13] and in many cases, the metastatic nodes are located outside the traditional neck dissection fields. Up to 75% of positive nodes are intra-or periparotid 11 and there is a recognized tendency to "skip-metastases" in levels III and IV without involvement of more proximal nodes.…”

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

“…A majority of salivary gland tumors occurs in the parotid or submandibular glands facilitating pretreatment cytologic evaluation by palpation‐ or ultrasound‐guided fine needle aspiration (FNA) 2‐15 . The results of FNA interpretation can have significant implications for the clinical and surgical management of salivary gland lesions 6,16‐25 . Reactive and inflammatory conditions (eg, chronic sialadenitis, lymphoepithelial sialadenitis) are typically managed by clinical observation or treated medically.…”

“…Benign neoplasms such as Warthin tumor and pleomorphic adenoma are either excised by a conservative surgical approach or, in some cases, patients may opt for close clinical monitoring that may include occasional sampling by FNA. Low‐grade SGCs are usually treated with conservative resection with negative margins, while high‐grade SGCs are often managed by a more radical resection 16,18,22‐25 that may include neck dissection 16,19,23‐28 and facial nerve sacrifice pre‐ or intraoperatively 29 …”