Salivary Glands tumors

Transcription

1 Salivary Glands tumors Sal.Gl. 1

2 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 2

3 Standard clinical evaluation Evidence Option complete history of the disease weight and weight loss > 10 % neck examination evaluation of cranial nerves V2,V3, VII drawing of any lesions FNA (US guided or not) Sal.Gl. 3

4 Advanced clinical evaluation Evidence Option dental examination by oral surgeon nutritional assessment panendoscopy for minor salivary gland tumor with biopsy Sal.Gl. 4

5 Laboratory tests Evidence Option hemogram, ionogram, coagulation tests, liver enzymes, kidney function Sal.Gl. 5

6 Imaging Evidence Option US+FNA (for parotid and submandibular glands) MRI/CT scan 1 Metastatic work-up: (chest X-ray, thoracic spiral CT scan) when cancer is suspected Additional examination depending on previous findings Orthopantomogram (+dental X-rays if needed) PET scan Invest. 1 see radiology guidelines Sal.Gl. 6

7 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 7

8 Staging Evidence Option TNM classification (5 th ed., 1997) WHO International Classification of Diseases for Oncology (ICD-O 9 or ICD-O 10) Sal.Gl. 8

9 Sal.Gl. 9 TNM/AJCC 1997 Staging Major salivary gland 1 TX: primary tumor cannot be assessed TO: no evidence of primary tumor T1: Tumor 2 cm or less in greatest dimension without extraparenchymal extension* T2: Tumor > 2 cm but 4 cm in greatest dimension without extraparenchymal extension* T3: Tumor having extraparenchymal extension* without seventh nerve involvement and/or more than 4 cm but no more than 6 cm in greatest dimension T4: Tumor invades base of skull, seventh nerve, and/or exceeds 6cm in greatest dimension 1 Minor salivary gland tumor are staged according to their site of origin *Extraparenchymal ext. is clin. or macroscop. evidence of invasion of skin, soft tissues, bone or nerve Microscopic evidence alone does not constitute extraparen. ext. for classif. purpose

10 TNM/AJCC 1997 Staging N0: no regional node metastasis Nx: regional nodes cannot be assessed N1: single ipsilateral node, 3 cm N2a: single ipsilateral node, > 3 cm and 6 cm N2b: multiple ipsilateral nodes, 6 cm N2c: controlateral or bilateral nodes, 6 cm N3: node > 6 cm Sal.Gl. 10

11 TNM/AJCC 1997 Staging M0: No distant metastasis M1: Distant metastasis Mx: Metastasis cannot be assessed Sal.Gl. 11

12 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 12

13 Malignant tumors: Primary treatment: general strategy Evidence Option Surgery: tumor and neck RxTh: tumor and neck Indiv. Sal.Gl. 13

14 Malignant tumors: Primary treatment: surgical procedure Evidence Option Primary tumor : radical excision with function preservation if possible Submandibular glands tumor: total submandibulectomy Parotid gland tumor: - superficial parotidectomy, or - total parotidectomy, or - radical parotidectomy (including VIIth nerve) Minor salivary glands tumor: depending on primary site Sal.Gl. 14

15 Sal.Gl. 15 Neck node managment in parotid tumor N0: treatment (surgery or RxTh) ) of levels I to IV in case of: - high grade tumor - nerve infiltration, perineural invasion - T3-T4 T4 tumor - extra glandular infiltration Treatment options: - Selective neck node dissection (±( ± post-op op RxTh 1 ) if anticipated - RxTh if post-op op for the T and/or non-anticipated N1: selective neck node dissection (II-IV) IV) ± post-op op RxTh 1 > N1: RMND (I-V) ± post-op op RxTh 1 1 See guidelines for post-op op RxTh Evidence Option

16 Malignant tumors: Primary treatment: post operative RxTh Positive tumor margin (R1) High T stage ( pt3) High tumor grade Nerve infiltration, perineural invasion Tumor extension beyond capsule Deep lobe tumor pn1 Lymph node invasion with capsular rupture 1 See clinical target volume for the nodes (slide 32) Evidence Option Sal.Gl. 16

17 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 17

18 Follow-up Evidence Option Oral and head and neck clinical examination (including a fiberoptic examination for laryngeal and hypopharyngeal tumor) every 6 w (first 6 months), every 3 months (years1-2), every 6 months (years 3-5), once/year ( > 5 years) WHO performance status Nutritional assessment Dental examination + orthopantomogram every 6 months Imaging: - MRI ± CT every year - Chest X-ray every year (malignant tumor only) Laboratory tests - thyroid function if post-operative RxTh Evolution of late toxicity (EORTC/RTOG) scale Indiv. Sal.Gl. 18

19 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 19

20 Salvage treatment for recurrent disease Evidence Option Loco regional disease: -surgery -RxTh -chemotherapy Metastatic disease: -chemotherapy Indiv. Indiv. Indiv. Indiv. Sal.Gl. 20

21 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 21

22 References Armstrong JG, Harrison LB, Thaler HT, Friedlander-Klar H, Fass DE, Zelefsky MJ, Shah JP, Strong EW, Spiro RH. The Indications for Elective Treatment of the Neck in Cancer of the Major Salivary Glands. Cancer 1992; 69 : Avery CME, Moody AB, McKinna FE, Taylor Jn Henk JM, Langdon JD. Combined treatment of adenoid cystic carcinoma of the salivary glands. Int J Oral Maxillofac Surg 2000; 29 : Belloc JB, Laccourreye O, Chabardes E, Carnot F, Brasnu D, Laccourreye H. Les tumeurs mucoépidermoïdes de la parotide. Attitude diagnostique et thérapeutique. Ann Oto-Laryngol 1991; 108 : Douglas JG, Lee S, Laramore GE, Austin-Seymour M, Koh W-j, Griffin TW. Neutron radiotherapy for the Treatment of Locally Advanced Major Salivary Gland Tumors. Head Neck 1999; 21 : Hoffman HT, Karnell LH, Robinson RA, Pinkston JA, Menck HR. National Cancer Data Base Report on Cancer of the Head and Neck: Acinic Cell Carcinoma. Head Neck 1999; 21 : Numata T, Muto H, Shiba K, Nagata H, Terada N, Konno A. Evaluation of the Validity of the 1997 International Union Against Cancer TNM Classification of Major Salivary Gland Carcinoma. Cancer 2000; 89 : Taylor BW, Brant TA, Mendenhall NP, Mendenhall WM, Cassisi NJ, Stringer SP, Million RR. Carcinoma of the Skin Metastatic to Parotid Area Lymph Nodes. Head & Neck 1991; 13 : Sal.Gl. 22