Carlson Julie, Licitra Lisa, Locati Laura, Raben David, Persson Fredrik, Stenman Göran
From the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO; Head and Neck Unit, Medical Oncology Department, Fondazione, IRCCS Istituto Tumori, Milan, Italy; Departments of Pathology and Oncology, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden.
Am Soc Clin Oncol Educ Book. 2013:257-63. doi: 10.14694/EdBook_AM.2013.33.257.
Malignant salivary gland tumors make up a small proportion of malignancies worldwide, yet vary widely in terms of histology, patterns of spread, and recurrence. A better understanding of this variability will guide appropriate treatment recommendations and lead to improved outcomes. Recent molecular genetic studies have uncovered a translocation-generated gene fusion network in salivary gland carcinomas that can be used for diagnosis, treatment decisions, and development of specific targeted therapies. The gene fusions encode novel fusion oncoproteins that function as transcriptional coactivators, tyrosine kinase receptors, and transcription factors involved in growth-factor signaling and cell-cycle regulation. While surgery currently is the primary therapy for operable tumors, radiation plays an important role in the postoperative setting, as well as in the definitive setting for inoperable lesions. An awareness of the risk factors for tumor recurrence and spread is important for both adjuvant therapy referrals and for radiation treatment planning purposes. Additionally, chemotherapy is being used increasingly in both the concurrent setting as a radiosensitizer, as well as in the palliative setting for metastatic tumors. Future trials investigating concurrent chemotherapy and radiation, as well as the use of targeted agents based on evolving molecular discoveries, will elucidate optimal personalized approaches for this challenging disease.
恶性唾液腺肿瘤在全球范围内的恶性肿瘤中占比很小，但在组织学、扩散模式和复发方面差异很大。更好地了解这种变异性将指导适当的治疗建议并改善治疗结果。最近的分子遗传学研究发现，唾液腺癌中存在一个由易位产生的基因融合网络，可用于诊断、治疗决策以及开发特定的靶向治疗方法。这些基因融合编码新型融合癌蛋白，它们作为转录共激活因子、酪氨酸激酶受体以及参与生长因子信号传导和细胞周期调控的转录因子发挥作用。虽然手术目前是可切除肿瘤的主要治疗方法，但放疗在术后环境以及不可切除病变的确定性治疗中都起着重要作用。了解肿瘤复发和扩散的危险因素对于辅助治疗转诊和放射治疗计划都很重要。此外，化疗在同步治疗中作为放射增敏剂的应用越来越多，在转移性肿瘤的姑息治疗中也是如此。未来研究同步化疗和放疗以及基于不断发展的分子发现使用靶向药物的试验，将阐明针对这种具有挑战性疾病的最佳个性化治疗方法。
