MANAGEMENT OF MALIGNANT-TUMORS OF THE SALIVARY-GLANDS

Results of treatment for patients with salivary gland carcinoma have i mproved in recent years, most likely due to earlier diagnosis and the use of more effective locoregional therapy. Salivary gland tumors are treated surgically, often in conjunction with postoperative radiation therapy when the tumor is malignant, Good results rest strongly on the performance of an adequate, en bloc initial resection. Radical neck d issection is indicated in patients with obvious cervical metastasis, a nn limited neck dissection may be appropriate in patients with clinica lly negative nodes in whom occult nodal involvement is likely. Postope rative radiation therapy should be administered when the tumor is high stage or high grade, the adequacy of the resection is in question, or the tumor has ominous pathologic features, Neutron beam therapy shows promise in controlling locoregional disease but requires further stud y. No single chemotherapeutic agent or combination regimen has produce d consistent results. At present, chemotherapy is clearly indicated on ly for palliation in symptomatic patients with recurrent and/or unrese ctable cancers. Patients with salivary gland carcinomas most be follow ed for long periods, as recurrence may occur a decade or more followin g therapy. Distant metastasis appears to occur in approximately 20% of patients.