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Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer

Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer. Claus Rödel Department of Radiation Therapy University of Frankfurt. Prognostic factors for locoregional control. T stage (T1/2 better than T3/4) Resection margin status

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Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer

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  1. Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer Claus Rödel Department of Radiation Therapy University of Frankfurt

  2. Prognostic factors for locoregional control • T stage (T1/2 better than T3/4) • Resection margin status • Tumor site (oral better than other sites) • Bone invasion • Perineural invasion • Treatment modality (OP+RT better OP) • Not the histologic type!? Therhaard et al. Head Neck 2004

  3. Postoperative RT recommended for: • pT3/4 or pN+ • Close (≤5mm) or incomplete (<1mm) resection • Bone invasion • Perineural invasion • Recurrent tumors

  4. Risk of positive neck nodes • Histologic type • T stage (T1:15%, T2:25%, T3/4:33%) • Tumor location

  5. Risk of positive neck nodes H IS T O L O G Y High risk: • Squamous cell • Undifferentiated • Salivary duct Intermediate risk: • Mucoepidermoid Low risk: • Acinic cell • Adenoid cystic • Carcinoma ex pleomorphic adenoma

  6. Risk estimation for positive neck nodes T1 = 1; T2 = 2; T3/4 = 3 Acinic or adenoid cystic or carcinom ex pleomorhic adenoma = 1 Mucoepidermoid = 2 Squamous cell or undifferentiated = 3 Terhaard et al., IJROBP 2007

  7. Elective treatment of neck nodes recommended for: • Parotid tumors for a score ≥ 4: Level Ib -III • Submandibular tumors: except for T1 acinic or adenoid cystic carcinoma: Level I-III • Minor salivary gland tumors: tumors in the tongue, floor of the mouth, pharynx or larynx • In case of pN+: homolateral level I-V

  8. CRITICAL POINTS FOR RT: • Clinical Target Definition • 3D-conformal, IMRT • High-LET (neutron, ions)? • Concurrent Chemotherapy or targeted therapy?

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