➤ In the setting of resectable, recurrent locoregional disease and distant
metastatic disease, regardless of prior treatment type, treatment
may include palliative revision resection and appropriate surgical
reconstruction and rehabilitation, if the metastatic disease is not rapidly
progressive or imminently lethal. (Moderate recommendation; EB-I)
➤ Patients undergoing revision surgery for recurrent salivary gland
cancer should be evaluated for potential adjuvant therapy. (Moderate
recommendation; EB-I)
Radiotherapy
➤ Post-operative RT should be offered to all patients with resected
adenoid cystic carcinoma. (Strong recommendation; EB-I)
➤ Post-operative RT should be offered to patients with tumors with the
following features: high grade tumors, positive margins; perineural
invasion; lymph node metastases; lymphatic/vascular invasion; and
T3–T4 tumors. (Strong recommendation; EB-I)
➤ Post-operative RT may be offered to patients with tumors with close
margins, or intermediate grade tumors. (Weak recommendation; IC-Ins)
➤ In post-operative cases, the high dose target should cover the
salivary gland surgical bed and appropriate nodal levels. (Strong
recommendation; EB-I)
➤ In the case of perineural invasion, the associated nerve(s) may be
covered with an elective/intermediate dose to the skull base. (Moderate
recommendation; IC-Ins)
➤ Elective nodal coverage may be offered for T3–T4 primary and high-
grade malignancies. (Moderate recommendation; IC-Ins)
➤ Radiation should be initiated within 8 weeks of surgery. (Moderate
recommendation; IC-Ins)
➤ Particle therapy, including proton, neutron, and carbon ion therapy, may
be used for patients with SGM. There are no indications for use of heavy
particle therapy over photon/electron therapy. (Weak recommendation;
EB-L)
➤ Elective neck irradiation may be offered in patients with cN0 disease for
the following indications: T3–T4 cancers or high-grade malignancies.
(Moderate recommendation; EB-I)
➤ Radiotherapy should be offered to patients with SGM who are not
candidates for surgical resection (due to extent of disease or medical
comorbidity). (Moderate recommendation; EB-I)
Note: The high dose target should cover the gross disease in the salivary gland and any
appropriate nodal levels.
