Stage III Major Salivary Gland Cancer
Low-grade Tumors
High-grade Tumors
Current Clinical Trials
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
information.)
Patients with low-grade stage III tumors of the salivary gland may be cured with surgery
alone.[1-3] Radiation therapy as primary treatment is not often required but
may be used for tumors for which resection involves a significant cosmetic or
functional deficit, or as an adjuvant to surgery when positive margins are
present.[4] Patients with low-grade tumors that have spread to lymph nodes may be cured with
resection of the primary tumor and the involved lymph nodes, with or without
radiation therapy. Neutron-beam therapy is effective in the treatment of
tumors that have spread to local lymph nodes.
Patients with high-grade stage III salivary gland tumors that are confined to the gland in
which they arise may be cured by surgery alone, though adjuvant postoperative
radiation therapy may be used, especially if positive margins are present.
Primary conventional x-ray radiation therapy may provide palliation for patients with unresectable tumors. Fast neutron beams, however, have been reported to
improve disease-free and overall survival in this clinical situation.[5-7] Patients with tumors that have spread to regional lymph nodes should have a regional
lymphadenectomy as part of the initial surgical procedure. Adjuvant radiation
therapy for these tumors may reduce the local recurrence rate.
Low-grade Tumors
Standard treatment options:
- Surgery alone or with postoperative radiation therapy when indicated.
- Chemotherapy should be considered in special circumstances, when radiation
or surgery are refused or when tumors are recurrent or nonresponsive.
Treatment options under clinical evaluation:
- Data with fast neutron-beam radiation have indicated superior results when
compared with conventional radiation therapy using x-rays. The role of
chemotherapy is under evaluation.[5,8-10]
High-grade Tumors
Standard treatment options:
- Patients with localized high-grade salivary gland tumors that are confined to the gland in
which they arise may be cured by radical surgery alone.[11,12]
- Postoperative radiation therapy may improve local control and increase
survival rates for patients with high-grade tumors, positive surgical
margins, or perineural invasion.[13][Level of evidence: 3iiiDii][14-16]
- Fast neutron-beam radiation or accelerated hyperfractionated photon beam
schedules have been reported to be more effective than conventional x-ray
therapy in the treatment of inoperable, unresectable, or recurrent malignant
salivary gland tumors.[5-7,17]
Treatment options under clinical evaluation:
- Clinical trials exploring ways to improve local control with radiation therapy
and/or radiosensitizers and with chemotherapy are under evaluation.[8-10,18,19]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III salivary gland cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Byers RM, Jesse RH, Guillamondegui OM, et al.: Malignant tumors of the submaxillary gland. Am J Surg 126 (4): 458-63, 1973.
[PUBMED Abstract]
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Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
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Woods JE, Chong GC, Beahrs OH: Experience with 1,360 primary parotid tumors. Am J Surg 130 (4): 460-2, 1975.
[PUBMED Abstract]
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Guillamondegui OM, Byers RM, Luna MA, et al.: Aggressive surgery in treatment for parotid cancer: the role of adjunctive postoperative radiotherapy. Am J Roentgenol Radium Ther Nucl Med 123 (1): 49-54, 1975.
[PUBMED Abstract]
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Krüll A, Schwarz R, Engenhart R, et al.: European results in neutron therapy of malignant salivary gland tumors. Bull Cancer Radiother 83 (Suppl): 125-9s, 1996.
[PUBMED Abstract]
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Douglas JG, Lee S, Laramore GE, et al.: Neutron radiotherapy for the treatment of locally advanced major salivary gland tumors. Head Neck 21 (3): 255-63, 1999.
[PUBMED Abstract]
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Douglas JG, Laramore GE, Austin-Seymour M, et al.: Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Int J Radiat Oncol Biol Phys 46 (3): 551-7, 2000.
[PUBMED Abstract]
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Kaplan MJ, Johns ME, Cantrell RW: Chemotherapy for salivary gland cancer. Otolaryngol Head Neck Surg 95 (2): 165-70, 1986.
[PUBMED Abstract]
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Eisenberger MA: Supporting evidence for an active treatment program for advanced salivary gland carcinomas. Cancer Treat Rep 69 (3): 319-21, 1985.
[PUBMED Abstract]
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Catterall M, Errington RD: The implications of improved treatment of malignant salivary gland tumors by fast neutron radiotherapy. Int J Radiat Oncol Biol Phys 13 (9): 1313-8, 1987.
[PUBMED Abstract]
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Spiro RH: Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 8 (3): 177-84, 1986 Jan-Feb.
[PUBMED Abstract]
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Theriault C, Fitzpatrick PJ: Malignant parotid tumors. Prognostic factors and optimum treatment. Am J Clin Oncol 9 (6): 510-6, 1986.
[PUBMED Abstract]
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Hosokawa Y, Shirato H, Kagei K, et al.: Role of radiotherapy for mucoepidermoid carcinoma of salivary gland. Oral Oncol 35 (1): 105-11, 1999.
[PUBMED Abstract]
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Garden AS, el-Naggar AK, Morrison WH, et al.: Postoperative radiotherapy for malignant tumors of the parotid gland. Int J Radiat Oncol Biol Phys 37 (1): 79-85, 1997.
[PUBMED Abstract]
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Mendenhall WM, Morris CG, Amdur RJ, et al.: Radiotherapy alone or combined with surgery for salivary gland carcinoma. Cancer 103 (12): 2544-50, 2005.
[PUBMED Abstract]
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Chen AM, Granchi PJ, Garcia J, et al.: 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 67 (4): 982-7, 2007.
[PUBMED Abstract]
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Wang CC, Goodman M: Photon irradiation of unresectable carcinomas of salivary glands. Int J Radiat Oncol Biol Phys 21 (3): 569-76, 1991.
[PUBMED Abstract]
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Suen JY, Johns ME: Chemotherapy for salivary gland cancer. Laryngoscope 92 (3): 235-9, 1982.
[PUBMED Abstract]
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Posner MR, Ervin TJ, Weichselbaum RR, et al.: Chemotherapy of advanced salivary gland neoplasms. Cancer 50 (11): 2261-4, 1982.
[PUBMED Abstract]
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