Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines

Abstract

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck.Recommendations• Ultrasound guided fine needle aspiration cytology is recommended for all salivary tumours and cytology should be reported by an expert histopathologist. (R)• Adjuvant radiotherapy (RT) following surgery is recommended for all malignant submandibular tumours except in cases of small, low-grade tumours that have been completely excised. (R)• For benign parotid tumours complete excision of the tumour should be performed and offers good cure rates. (R)• In the event of intra-operative tumour spillage, most cases need long-term follow-up for clinical observation only. These should be raised in the multidisciplinary team to discuss the merits of adjuvant RT. (G)• As a general principle, if the facial nerve function is normal pre-operatively then every attempt to preserve facial nerve function should be made during parotidectomy and if the facial nerve is divided intra-operatively then immediate microsurgical repair (with an interposition nerve graft if required) should be considered. (G)• Neck dissection is recommended in all cases of malignant parotid tumours except for low-grade small tumours. (R)• Where malignant parotid tumours lie in close proximity to the facial nerve there should be a low threshold for adjuvant RT. (G)• Adjuvant RT should be considered in high grade or large tumours or in cases where there is incomplete or close resection margin. (R)• Adjuvant RT should be prescribed on the basis of clinical factors in addition to histology and grade, e.g. stage, pre-operative facial weakness, positive margins, peri-neural invasion and extracapsular spread. (R)