Mendonça Joana C, Barbosa Ana, Vieira Claudia, Dinis José
Oncology, Hospital da Senhora da Oliveira, Guimarães, PRT.
Medical Oncology, Instituto Português de Oncologia do Porto, Porto, PRT.
Cureus. 2023 Aug 5;15(8):e42983. doi: 10.7759/cureus.42983. eCollection 2023 Aug.
Salivary gland cancers are rare and heterogenous malignancies which makes it hard to standardize treatments with good evidence levels. The localized disease approach is well established, with surgery to the primary site and adjuvant radiation therapy in patients with high-risk features. Treatment of advanced disease should be multidisciplinary. Local approaches, which include radiation therapy, surgery, and thermoablation, among others, have the potential to achieve durable disease control with low toxicity. Chemotherapy has shown disappointing results, so systemic treatment should be guided by actionable genetic alterations, which in salivary gland cancers rely on the histologic type. When directed molecular tests are not useful, a multigene panel should be performed. This case is a good example of how to integrate all these possible tretaments in clinical practice, including molecular testing and target treatment.
唾液腺癌是罕见的异质性恶性肿瘤,这使得很难用充分的证据水平来规范治疗。局限性疾病的治疗方法已得到充分确立,即对原发部位进行手术,并对具有高危特征的患者进行辅助放疗。晚期疾病的治疗应采用多学科方法。局部治疗方法,包括放疗、手术和热消融等,有可能以低毒性实现持久的疾病控制。化疗结果令人失望,因此全身治疗应以可操作的基因改变为指导,在唾液腺癌中这取决于组织学类型。当直接的分子检测无用时,应进行多基因检测。这个病例是一个很好的例子,展示了如何在临床实践中整合所有这些可能的治疗方法,包括分子检测和靶向治疗。