Tükürük Bezi Kanserleri
Özet
Tükürük bezi kanserleri, başlıca parotis, submandibular, sublingual ve minör tükürük bezlerinde görülen nadir malignitelerdir ve tüm baş ve boyun kanserlerinin yaklaşık %3-5'ini oluşturur. Bu kanserler, büyük histolojik heterojeniteye sahip olup yavaş seyirli düşük dereceli türlerden hızlı ilerleyen yüksek dereceli türlere kadar geniş bir spektrumda yer alır. Histolojik alt türler arasında adenoid kistik karsinom, mukoepidermoid karsinom ve asiner hücreli karsinom en sık görülen histolojik tiplerdir. Yüksek dereceli tümörler, perineural ve vasküler invazyon gibi özelliklere sahip olup nüks riski taşır.
Tedavi genellikle cerrahi eksizyon, adjuvan radyoterapi ve bazen sistemik tedaviyi kapsar. Cerrahi sırasında yüz sinirinin korunması ve pozitif cerrahi sınırın önlenmesi gibi unsurlar önemlidir. Radyoterapi, lokal kontrolü artırırken, kemoterapi ileri evre vakalarda veya metastaz durumunda uygulanır. Tedavi sonrası takip, nüksün erken dönemde tespitini ve tedavi sonrası komplikasyonların yönetimini hedefler. Bu süreçte düzenli klinik değerlendirme ve görüntüleme yöntemlerinin yanı sıra, komplikasyonların önlenmesi için multidisipliner bir yaklaşım gereklidir.
Salivary gland cancers are rare malignancies primarily occurring in the parotid, submandibular, sublingual, and minor salivary glands, accounting for approximately 3-5% of all head and neck cancers. These cancers exhibit significant histological heterogeneity, ranging from slow-growing low-grade types to rapidly progressing high-grade types. The most common histological subtypes include adenoid cystic carcinoma, mucoepidermoid carcinoma, and acinic cell carcinoma. High-grade tumors often feature perineural and vascular invasion, posing a high risk of recurrence.
Treatment typically involves surgical excision, adjuvant radiotherapy, and sometimes systemic therapy. During surgery, preserving the facial nerve and avoiding positive surgical margins are critical. Radiotherapy enhances local control, while chemotherapy is applied in advanced cases or those with metastasis. Post-treatment follow-up aims to detect recurrences early and manage complications effectively. This process requires regular clinical evaluations, imaging modalities, and a multidisciplinary approach to prevent and address complications.
Referanslar
Steuer CE, Hanna GJ, Viswanathan K, Bates JE, Kaka AS, Schmitt NC, et al. The evolving landscape of salivary gland tumors. CA: a cancer journal for clinicians. 2023;73(6):597-619.
Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, et al. Management of salivary gland malignancy: ASCO guideline. Journal of Clinical Oncology. 2021;39(17):1909-41.
van Herpen C, Vander Poorten V, Skalova A, Terhaard C, Maroldi R, van Engen A, et al. Salivary gland cancer: ESMO–European Reference Network on Rare Adult Solid Cancers (EURACAN) clinical practice guideline for diagnosis, treatment and follow-up. ESMO open. 2022;7(6):100602.
Cheraghlou S, Schettino A, Zogg CK, Otremba MD, Bhatia A, Park HS, et al. Adjuvant Chemotherapy Is Associated With Improved Survival for Late‐Stage Salivary Squamous Cell Carcinoma. The Laryngoscope. 2019;129(4):883-9.
Feinstein TM, Lai SY, Lenzner D, Gooding W, Ferris RL, Grandis JR, et al. Prognostic factors in patients with high‐risk locally advanced salivary gland cancers treated with surgery and postoperative radiotherapy. Head & neck. 2011;33(3):318-23.
Cheraghlou S, Kuo P, Mehra S, Agogo GO, Bhatia A, Husain ZA, et al. Adjuvant therapy in major salivary gland cancers: analysis of 8580 patients in the National Cancer Database. Head & neck. 2018;40(7):1343-55.
Green B, Rahimi S, Brennan PA. Salivary gland malignancies–an update on current management for oral healthcare practitioners. Oral diseases. 2016;22(8):735-9.
Wang L, Li H, Yang Z, Chen W, Zhang Q. Outcomes of primary squamous cell carcinoma of major salivary glands treated by surgery with or without postoperative radiotherapy. Journal of Oral and Maxillofacial Surgery. 2015;73(9):1860-4.
Amini A, Waxweiler TV, Brower JV, Jones BL, McDermott JD, Raben D, et al. Association of adjuvant chemoradiotherapy vs radiotherapy alone with survival in patients with resected major salivary gland carcinoma: data from the National Cancer Data Base. JAMA Otolaryngology–Head & Neck Surgery. 2016;142(11):1100-10.
Airoldi M, Pedani F, Succo G, Gabriele AM, Ragona R, Marchionatti S, et al. Phase II randomized trial comparing vinorelbine versus vinorelbine plus cisplatin in patients with recurrent salivary gland malignancies. Cancer. 2001;91(3):541-7.
Fushimi C, Tada Y, Takahashi H, Nagao T, Ojiri H, Masubuchi T, 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. Annals of Oncology. 2018;29(4):979-84.
Ghosal N, Mais K, Shenjere P, Julyan P, Hastings D, Ward T, et al. Phase II study of cisplatin and imatinib in advanced salivary adenoid cystic carcinoma. British Journal of Oral and Maxillofacial Surgery. 2011;49(7):510-5.
Cohen RB, Delord J-P, Doi T, Piha-Paul SA, Liu SV, Gilbert J, et al. Pembrolizumab for the treatment of advanced salivary gland carcinoma: findings of the phase 1b KEYNOTE-028 study. American journal of clinical oncology. 2018;41(11):1083-8.
VanKoevering KK, Sabetsarvestani K, Sullivan SE, Barkan A, Mierzwa M, McKean EL. Pituitary dysfunction after radiation for anterior skull base malignancies: incidence and screening. Journal of Neurological Surgery Part B: Skull Base. 2020;81(01):075-81.
Cohen EE, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, et al. American Cancer Society head and neck cancer survivorship care guideline. CA: a cancer journal for clinicians. 2016;66(3):203-39.
Heineman TE, Kuan EC, St. John MA. When should surveillance imaging be performed after treatment for head and neck cancer? The Laryngoscope. 2017;127(3):533-4.
Bhattacharyya N, Fried MP. Determinants of survival in parotid gland carcinoma: a population-based study. American journal of otolaryngology. 2005;26(1):39-44.
Ehrsson YT, Langius-Eklöf A, Laurell G. Nutritional surveillance and weight loss in head and neck cancer patients. Supportive care in cancer. 2012;20:757-65.
Koyuncu M, ŞeŞen T, Akan H, Ismailoglu AA, Tanyeri Y, Tekat A, et al. Comparison of computed tomography and magnetic resonance imaging in the diagnosis of parotid tumors. Otolaryngology—Head and Neck Surgery. 2003;129(6):726-32.
Celebi I, Mahmutoglu AS, Ucgul A, Ulusay SM, Basak T, Basak M. Quantitative diffusion-weighted magnetic resonance imaging in the evaluation of parotid gland masses: a study with histopathological correlation. Clinical imaging. 2013;37(2):232-8.
Yuan Y, Tang W, Tao X. Parotid gland lesions: separate and combined diagnostic value of conventional MRI, diffusion-weighted imaging and dynamic contrast-enhanced MRI. The British journal of radiology. 2016;89(1060):20150912.
Choi DS, Na DG, Byun HS, Ko YH, Kim CK, Cho JM, et al. Salivary gland tumors: evaluation with two-phase helical CT. Radiology. 2000;214(1):231-6.
Kato H, Kanematsu M, Watanabe H, Mizuta K, Aoki M. Salivary gland tumors of the parotid gland: CT and MR imaging findings with emphasis on intratumoral cystic components. Neuroradiology. 2014;56:789-95.
Mehanna H, Wong W-L, McConkey CC, Rahman JK, Robinson M, Hartley AG, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. New England Journal of Medicine. 2016;374(15):1444-54.
Furukawa M, Hashimoto K, Kitani Y, Yoshida M. Point-of-care ultrasound in the head and neck region. Journal of Medical Ultrasonics. 2022;49(4):593-600.
Maraghelli D, Pietragalla M, Cordopatri C, Nardi C, Peired AJ, Maggiore G, et al. Magnetic resonance imaging of salivary gland tumours: key findings for imaging characterisation. European Journal of Radiology. 2021;139:109716.
Zheng N, Li R, Liu W, Shao S, Jiang S. The diagnostic value of combining conventional, diffusion-weighted imaging and dynamic contrast-enhanced MRI for salivary gland tumors. The British journal of radiology. 2018;91(1089):20170707.
Moradi F. Positron Emission Tomography and Molecular Imaging of Head and Neck Malignancies. Current Radiology Reports. 2020;8(11):21.
Soo J, Jin MC, Beadle BM, Holsinger FC, Finegersh A. Circulating tumor DNA in head and neck cancer: Early successes and future promise. Cancer (0008543X). 2022;128(11).
Witt RL. Major salivary gland cancer. Surgical Oncology Clinics. 2004;13(1):113-27.
Kordzińska-Cisek I, Grzybowska-Szatkowska L. Complications of radio-and radiochemotherapy in patients undergoing major salivary gland cancer surgery. Polish Journal of Otolaryngology. 2019;73(3):26-31.
Becker C, Pfeiffer J, Lange K, Dahlem KKK. Health-related quality of life in patients with major salivary gland carcinoma. European Archives of Oto-Rhino-Laryngology. 2018;275:997-1003.
Sood S, McGurk M, Vaz F. Management of salivary gland tumours: United Kingdom national multidisciplinary guidelines. The journal of Laryngology & otology. 2016;130(S2):S142-S9.
Freling N, Crippa F, Maroldi R. Staging and follow-up of high-grade malignant salivary gland tumours: The role of traditional versus functional imaging approaches–A review. Oral oncology. 2016;60:157-66.
Toper MH, Sarioglu S. Molecular pathology of salivary gland neoplasms: diagnostic, prognostic, and predictive perspective. Advances in anatomic pathology. 2021;28(2):81-93.
