Major and minor salivary gland cancers represent approximately 5 to 10 percent of head and neck malignancies.134 135 In general, surgery and/or radiation have been the principle treatment modalities, with chemotherapy primarily used in the recur-rent/metastatic disease setting. As a single modality, chemotherapy is not curative.
Because of the relative rarity and heterogeneity of these tumors, the available data on the efficacy of systemic therapy is often of poor quality. Many series are small, are developed in a retrospective manner, and combine different salivary gland cancer subtypes even though drug activity may vary among them.136 Single-agent activity has been shown for doxorubicin, cisplatin, 5-fluorouracil, and selected other drugs.137-142 The minority of patients will have a major response. In general, the response rates associated with combination therapy are higher than those with a single agent. Selected combination regimens are summarized in Table 22-10. The combination of cyclophosphamide, doxorubicin and cisplatin is probably the most widely used. The clinical benefit of combination versus single-agent therapy, however, has not been well studied. Considering investigational, even phase I, studies from the outset for such patients is quite reasonable. There is currently no demonstrated role for induction or adjuvant chemotherapy. As with squamous cell head and neck cancers, concurrent chemotherapy/radiation is often considered for unresectable tumors, although the practice guidelines for one major organization specify radiation alone (neutrons or photons) as the recommended therapy for these patients.147
Often initial close observation is the best treatment option for certain patients. Many of these tumors may behave in an indolent manner. A good example is adenoid cystic carcinoma, a subtype that, even while associated with frequent distant metastases, can relapse late and grow slowly for years, especially when the metastases are limited to the lung (Figure 22-3).
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