Management of Salivary Gland Malignancy: ASCO Guideline

Abstract

PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Patterns of care analysis for salivary gland cancer: a survey within the German Society of Radiation Oncology (DEGRO) and recommendations for daily practice

“…Overall, the preferred treatment technique was IMRT in concordance with the literature [13]. In case of treating AdCC in the primary situation, 50% of the participants would prefer carbon ion RT.…”

“…Furthermore, following analysis of the benefit of PORT on local tumor control after adjustment for T-stage, Ali et al recommended PORT for all AdCC patients, possibly with the exception of small T1 tumors without adverse features [36]. PORT for all AdCC is also strongly recommended by the current ASCO guidelines [13]. For targeting the primary tumor region, radiation doses of over 60 Gy for AdCC were recommended by Chen et al [16].…”

“…In definitive photon RT of AdCC applying doses >70 Gy, local control rates after 5 and 10 years of 56% and 43% for all T-stages and of K RT radiotherapy, PORT postoperative radiotherapy, IMRT intensity-modulated radiotherapy, AdCC adenoid cystic carcinoma, CTX chemotherapy, SGC salivary gland cancer K 44% and 30% in T4 tumors only were reported, respectively [17]. According to ASCO guidelines, for patients with unresectable disease, the primary tumor and gross nodal disease should be treated with 70 Gy in 2-Gy fractions [13]. Regarding the former primary tumor region for PORT, a minimum dose of 60 Gy following complete tumor resection and 66 Gy in case of positive resection margins have been recommended before [1].…”

Clinicopathological characteristics and outcomes of 23 patients with secretory carcinoma of major salivary glands

“…The NCCN Clinical Practice Guidelines in Oncology (Head and Neck Cancers, Version 2.2020) and ASCO Guidelines (Management of Salivary Gland Malignancy) on the diagnosis and treatment of SCSG with NTRK alterations have been revised 6 , 7 . Before the revision, research on the clinical characteristics, treatment, and outcomes of this tumor was limited 8 .…”

A Rational Approach to Unilateral Neck RT for Head and Neck Cancers in the Era of Immunotherapy

“…Eliminating RT to the elective contralateral neck has been shown to reduce the severity of radiotherapy-induced lymphopenia compared to bilateral neck RT, an effect likely attributable to reducing total irradiated blood volume [ 28 , 29 , 30 ]. Yet outside select cases of lateralized tonsil [ 31 , 32 , 33 ], salivary gland [ 34 ], or buccal mucosal cancers [ 35 ], routine implementation of unilateral neck RT is limited due to concerns regarding patterns of micrometastatic lymph node spread in more midline primary tumors [ 36 ].…”