Speicheldrüsentumoren: Limitationen der internationalen Guidelines und Bearbeitungsstand der AWMF-S3-Leitlinie

Primäre Speicheldrüsenkarzinome sind eher seltene Kopf-Hals-Tumoren, und man unterscheidet viele histologische Typen. Klinisch lassen sich maligne Tumoren oft nicht von benignen unterscheiden, sodass dies dann erst durch die histopathologische Diagnose möglich ist. Die wichtigsten internationalen Leitlinien zur Versorgung von Speicheldrüsentumoren sowie der aktuelle Stand der ersten deutschen S3-Leitlinie zu diesem Thema werden hier vorgestellt.

Abstract

Primary salivary gland carcinomas are not among the common head and neck tumors. They are characterized by manifold different histological types. Clinically, malignant tumors often cannot be distinguished from benign tumors, so that in these cases malignancy is only established by histopathological diagnosis. These are all reasons why there are relatively few clinical trials on the diagnosis, therapy and follow-up of these tumors. This in turn has the consequence that often only recommendations with limited evidence can be made in clinical guidelines. The most important international guidelines are the National Comprehensive Cancer Network (NCCN) guideline of 2023, the American Society of Clinical Oncology (ASCO) guideline of 2021, the European Society for Medical Oncology (ESMO) guideline of 2022 and still the British National Multidisciplinary guideline of 2016. These 4 international guidelines with their strengths and limitations are presented and commented here. Against this background, the development of a first German S3 clinical guideline on salivary gland tumors is important and expected to be completed in 2023. For the first time in the German guideline program on oncology, benign and malignant tumors are presented together in order to comprehensively do justice to the special features of salivary gland tumors.

Kernaussagen

• Bislang können wir uns bei der Behandlung von Speicheldrüsentumoren nur an wenigen internationalen Leitlinien orientieren, deren Empfehlungen häufig kein hohes Evidenzniveau erreichen.

• Die deutsche S3-Leitlinie zu Speicheldrüsentumoren ist bald fertiggestellt und wird die Evidenz der Diagnostik, Therapie und Nachsorge auf hohem methodischem Niveau abbilden.

• Die dargestellten internationalen Guidelines und auch bald die deutsche Leitlinie machen aber auch klar, dass in vielen Bereichen der Behandlung gezielte klinische Studien notwendig sind, um bessere Therapieempfehlungen treffen zu können.

Schlüsselwörter

Speicheldrüsen - Leitlinie - Tumor - Glandula parotis - Glandula submandibularis - Glandula sublingualis - kleine Speicheldrüsen - Diagnostik - Therapie - Chirurgie - Radiotherapie - Nachsorge

Keywords

Salivary glands - guideline - tumor - parotid gland - submandibular gland - sublingual gland - minor salivary glands - diagnosis - therapy - surgery - radiotherapy - aftercare

Publication History

Article published online:
06 February 2024

• Literatur

• 1 Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) DKDuDKD. S3-Leitlinie Diagnostik und Therapie des Mundhöhlenkarzinoms. 2021
• 2 AWMF S3 Leitlinie Diagnostik, Therapie und Nachsorge des Larynxkarzinoms. 2019; Registernummer 017-076OL gültig bis 30.01.2024.
• 3 Eneroth CM. Salivary gland tumors in the parotid gland, submandibular gland, and the palate region. Cancer 1971; 27: 1415-1418 DOI: 10.1002/1097-0142(197106)27:63.0.co;2-x. (PMID: 4325986)
• 4 Bradley PJ, McGurk M. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg 2013; 51: 399-403 DOI: 10.1016/j.bjoms.2012.10.002. (PMID: 23103239)
• 5 Thielker J, Grosheva M, Ihrler S. et al. Contemporary Management of Benign and Malignant Parotid Tumors. Front Surg 2018; 5 DOI: 10.3389/fsurg.2018.00039. (PMID: 29868604)
• 6 Vander PV, Balm AJ, Hilgers FJ. et al. The development of a prognostic score for patients with parotid carcinoma. Cancer 1999; 85: 2057-2067
• 7 Guntinas-Lichius O, Wendt TG, Buentzel J. et al. Incidence, treatment, and outcome of parotid carcinoma, 1996–2011: a population-based study in Thuringia, Germany. J Cancer Res Clin Oncol 2015; 141: 1679-1688 DOI: 10.1007/s00432-015-1961-y. (PMID: 25800621)
• 8 Ihrler S, Agaimy A, Guntinas-Lichius O. et al. WHO-Klassifikation 2017: Neues zu Tumoren der Speicheldrüsen. Der Pathologe 2018; 39: 11-17
• 9 Weaver AN, Lakritz S, Mandair D. et al. A molecular guide to systemic therapy in salivary gland carcinoma. Head Neck 2023; 45: 1315-1326 DOI: 10.1002/hed.27307. (PMID: 36859797)
• 10 Rieke DT, Schroder S, Schafhausen P. et al. Targeted treatment in a case series of AR+, HRAS/PIK3CA co-mutated salivary duct carcinoma. Frontiers in oncology 2023; 13: 1107134 DOI: 10.3389/fonc.2023.1107134. (PMID: 37427101)
• 11 NCCN Guidelines for Head and Neck Cancers. Version 2.2023.
• 12 Geiger JL, Ismaila N, Beadle B. et al. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39: 1909-1941 DOI: 10.1200/JCO.21.00449. (PMID: 33900808)
• 13 Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. The Journal of laryngology and otology 2016; 130: S142-S149 DOI: 10.1017/S0022215116000566. (PMID: 27841127)
• 14 van Herpen C, Vander Poorten V, Skalova 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: 100602
• 15 Terhaard CH, Lubsen H, Rasch CR. et al. The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys 2005; 61: 103-111 DOI: 10.1016/j.ijrobp.2004.03.018. (PMID: 15629600)
• 16 Bernier J, Cooper JS, Pajak TF. et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005; 27: 843-850 DOI: 10.1002/hed.20279. (PMID: 16161069)
• 17 Fayette J, Even C, Digue L. et al. NISCAHN: A phase II, multicenter nonrandomized trial aiming at evaluating nivolumab (N) in two cohorts of patients (pts) with recurrent/metastatic (R/M) salivary gland carcinoma of the head and neck (SGCHN), on behalf of the Unicancer Head & Neck Group. J Clin Oncol 2019; 37: 6083
• 18 Nachtsheim L, Prinz J, Arolt C. et al. Novel therapeutic approaches for salivary gland carcinomas. Laryngorrhinootologie 2022; 101 (11) 876-881 DOI: 10.1055/a-1792-2246. (PMID: 35320850)
• 19 Guntinas-Lichius O, Thielker J, Robbins KT. et al. Prognostic role of intraparotid lymph node metastasis in primary parotid cancer: Systematic review. Head Neck 2021; 43: 997-1008 DOI: 10.1002/hed.26541. (PMID: 33169420)
• 20 Abdel Razek AAK, Mukherji SK. State-of-the-Art Imaging of Salivary Gland Tumors. Neuroimaging Clin N Am 2018; 28: 303-317 DOI: 10.1016/j.nic.2018.01.009. (PMID: 29622121)
• 21 Muntean DD, Dudea SM, Baciut M. et al. The Role of an MRI-Based Radiomic Signature in Predicting Malignancy of Parotid Gland Tumors. Cancers 2023; 15 DOI: 10.3390/cancers15133319. (PMID: 37444429)