Speicheldrüsentumoren – eine interdisziplinäre Herausforderung

Speicheldrüsentumoren sind vergleichsweise selten und zeichnen sich durch eine heterogene Biologie aus. Entsprechend individuell sind die klinischen Verläufe und das Management der Erkrankung. In diesem Artikel beleuchten wir das aktuelle chirurgische Vorgehen für lokalisierte Stadien, den Stellenwert der Strahlentherapie sowie etablierte und neue Konzepte der palliativen Systemtherapie zur Behandlung von fortgeschrittenen Stadien.

Kernaussagen

• Die chirurgische Therapie ist der Standard im kurativen Setting.

• Die Durchführung einer elektiven Neck-Dissection wird bei großen Tumoren und High-grade-Neoplasien empfohlen.

• Die Strahlentherapie hat ihren Stellenwert in der Adjuvanz bei hohem Rezidivrisiko.

• Die palliative Systemtherapie muss an die Histologie des Tumors und den individuellen Krankheitsverlauf angepasst werden.

Schlüsselwörter

Speicheldrüsentumoren - Gl. parotis - adenoidzystisches Karzinom - sekretorisches Speicheldrüsenkarzinom - Photonentherapie - zielgerichtete Therapie

Publication History

Article published online:
25 November 2022

• Literatur

• 1 Pinkston JA, Cole P. Incidence Rates of Salivary Gland Tumors: Results from a Population-Based Study. Otolaryngology–Head and Neck Surgery 1999; 120 (06) 834-840
• 2 Schmidt RL, Hall BJ, Layfield LJ. A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Ultrasound-Guided Core Needle Biopsy for Salivary Gland Lesions. American Journal of Clinical Pathology 2011; 136 (04) 516-526
• 3 Novoa E. et al. Diagnostic value of core needle biopsy and fine-needle aspiration in salivary gland lesions. Head Neck 2016; 38: E346-52
• 4 Mighell AJ, High AS. Histological identification of carcinoma in 21 gauge needle tracks after fine needle aspiration biopsy of head and neck carcinoma. J Clin Pathol 1998; 51 (03) 241-243
• 5 Geiger JL. et al. Management of Salivary Gland Malignancy: ASCO Guideline. Journal of Clinical Oncology 2021; 39 (17) 1909-1941
• 6 Green BS, RahimiBrennan PA. Current management of the neck in salivary gland carcinomas. Journal of Oral Pathology & Medicine 2017; 46 (03) 161-166
• 7 Westergaard-Nielsen M. et al. Elective neck dissection in patients with salivary gland carcinoma: A systematic review and meta-analysis. J Oral Pathol Med 2020; 49 (07) 606-616
• 8 Chen Y. et al. Role of Postoperative Radiotherapy in Nonmetastatic Head and Neck Adenoid Cystic Carcinoma. J Natl Compr Canc Netw 2020; 18 (11) 1476-1484
• 9 Jensen AD. et al. COSMIC: A Regimen of Intensity Modulated Radiation Therapy Plus Dose-Escalated, Raster-Scanned Carbon Ion Boost for Malignant Salivary Gland Tumors: Results of the Prospective Phase 2 Trial. Int J Radiat Oncol Biol Phys 2015; 93 (01) 37-46
• 10 Lang K. et al. Adenoid cystic Carcinoma and Carbon ion Only irradiation (ACCO): Study protocol for a prospective, open, randomized, two-armed, phase II study. BMC Cancer 2021; 21 (01) 812
• 11 Hayashi K. et al. A retrospective multicenter study of carbon-ion radiotherapy for major salivary gland carcinomas: Subanalysis of J-CROS 1402 HN. Cancer Science 2018; 109 (05) 1576-1582
• 12 Palma DA. et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol 2020; 38 (25) 2830-2838
• 13 Dreyfuss AI. et al. Cyclophosphamide, doxorubicin, and cisplatin combination chemotherapy for advanced carcinomas of salivary gland origin. Cancer 1987; 60 (12) 2869-2872
• 14 Licitra L. et al. Cisplatin, doxorubicin and cyclophosphamide in advanced salivary gland carcinoma. A phase II trial of 22 patients. Ann Oncol 1996; 7 (06) 640-642
• 15 Gilbert J. et al. Phase II trial of taxol in salivary gland malignancies (E1394): a trial of the Eastern Cooperative Oncology Group. Head Neck 2006; 28 (03) 197-204
• 16 Tchekmedyian V. et al. Phase II Study of Lenvatinib in Patients With Progressive, Recurrent or Metastatic Adenoid Cystic Carcinoma. J Clin Oncol 2019; 37 (18) 1529-1537
• 17 Thomson DJ. et al. Phase II trial of sorafenib in advanced salivary adenoid cystic carcinoma of the head and neck. Head Neck 2015; 37 (02) 182-187
• 18 Locati LD. et al. Phase II trial with axitinib in recurrent and/or metastatic salivary gland cancers of the upper aerodigestive tract. Head Neck 2019; 41 (10) 3670-3676
• 19 Takahashi H. et al. Phase II Trial of Trastuzumab and Docetaxel in Patients With Human Epidermal Growth Factor Receptor 2-Positive Salivary Duct Carcinoma. J Clin Oncol 2019; 37 (02) 125-134
• 20 Fushimi C. et al. A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma. Ann Oncol 2018; 29 (04) 979-984
• 21 Hong DS. et al. Larotrectinib in patients with TRK fusion-positive solid tumours: a pooled analysis of three phase 1/2 clinical trials. Lancet Oncol 2020; 21 (04) 531-540
• 22 Doebele RC. et al. Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1–2 trials. Lancet Oncol 2020; 21 (02) 271-282
• 23 Cohen RB. et al. Pembrolizumab for the Treatment of Advanced Salivary Gland Carcinoma: Findings of the Phase 1b KEYNOTE-028 Study. Am J Clin Oncol 2018; 41 (11) 1083-1088
• 24 Mahmood U. et al. A Randomized Phase 2 Study of Pembrolizumab With or Without Radiation in Patients With Recurrent or Metastatic Adenoid Cystic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 109 (01) 134-144
• 25 Marabelle A. et al. Association of tumour mutational burden with outcomes in patients with advanced solid tumours treated with pembrolizumab: prospective biomarker analysis of the multicohort, open-label, phase 2 KEYNOTE-158 study. Lancet Oncol 2020; 21 (10) 1353-1365