First-line treatment for salivary gland cancer is surgery. The surgeon will remove the affected salivary gland and possibly some surrounding tissue. If nearby lymph nodes are thought to be involved, they will also be removed, and a neck dissection will be performed.
In cases of higher-grade or larger tumors, unclean surgical margins or evidence of lymph node metastasis, postoperative radiation therapy is recommended to improve clinical outcomes. It may be used by itself in cases where the tumor may be too large to be removed surgically, where surgery would be disfiguring, or if the tumor is inoperable for other reasons. It is useful for reducing symptoms such as pain and difficulty in swallowing.
City of Hope’s
was the first in the western United States to offer the helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
Radiation therapy is a localized treatment, which means it provides benefits — and side effects — in the exact area where it’s delivered. By reducing the radiation dose to an area of normal, healthy tissue, a patient will experience potentially fewer side effects than they would in a more conventional treatment setting. This is especially important in the treatment of cancers of the head and neck region. If the radiation dose can be spared to any portion of the oral cavity (mouth) or throat, the patient will experience significant fewer problems in making their way through the course of treatment. This advanced technique makes it possible to reduce the dose to the parotid gland, hence – saliva is preserved – lessening a patient’s possibility of having a dry mouth. In addition, TomoTherapy can assist in reducing dose to the normal swallowing muscles. This can improve a patient’s ability to continue eating – directly impacting a patient’s quality of life.
Chemotherapy is sometimes used with radiation in cases of salivary gland cancer where the disease is metastatic, unresectable and/or recurrent. It may also be employed postsurgically (along with radiation) in late-stage or aggressive cancers. Chemotherapy regimens vary depending on the particular cell type in question.
City of Hope has several clinical trials involving experimental therapies for advanced solid tumors of the head and neck. Some of these may apply to salivary cancer. One clinical trial includes the use of cetuximab (Erbitux), a monoclonal antibody that inhibits EGFR (epidermal growth factor receptor), impairing the growth of cancer cells. Sometimes, this is combined with radiation and chemotherapy.
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Because salivary gland cancer can recur, patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include thorough head and neck palpation as well as multiple imaging modalities, e.g., ultrasound, CT, magnetic resonance imaging and positron emission tomography scans.