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.[1,2,3] 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.[5,6,7] 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:

1. Surgery alone or with postoperative radiation therapy when indicated.
2. 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.[5,8,9,10]

High-grade Tumors

STANDARD TREATMENT OPTIONS:

1. 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]
2. 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]
3. 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.[5,6,7,15]

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.[8,9,10,16,17]