See also:
Surgery
The removal of the affected gland (with clear margins if possible) is generally considered the surgical treatment of choice. The extensive perineural spread commonly associated with adenoid cystic carcinoma creates difficulties in obtaining negative margins. Concerns about inducing additional morbidity with efforts to encompass perineural spread has generated support for more conservative resections followed by irradiation. Additional concerns about development of distant metastases must be considered.
Radiation
Adenoid Cystic Carcinoma is considered radiosensitive, and radiotherapy after tumor debulking may be an option
Chemotherapy/Immune Modulation/Targeted Therapy
See search engine for clinical trials:
- Go to clinicaltrials.gov
- In "Condition or Disease" search engine, type in adenoid cystic carcinoma (https://clinicaltrials.gov/ct2/home)
Observation
Adenoid cystic carcinoma is not a benign disease, but most commonly progresses slowly over years. Some cases are more aggressive. Observation may be a reasonable management for rare selected patients with signficant comorbidities who carefully weigh the pros/cons to the slow progression of untreated cancer against the morbidity of treatment. Observation is commonly practiced for patients with recurrent disease or distant spread (lung metastases) with the understanding that holding on specific cancer directed therapy is not equivalent to no treatment. Supportive care, monitoring progress, and maintenance of contact to introduce advances (see ref below Gupta et al 2009) are all components of the observation management plan.
References
Signaling pathways in adenoid cystic cancers: implications for treatment.Gupta AK, Wilke WW, Taylor EN, Bodeker KL, Hoffman HT, Milhem MM, Buatti JM, Robinson RA.Cancer Biol Ther. 2009 Oct;8(20):1947-51.
Role of radiotherapy in adenoid cystic carcinoma of the head and neck. Iseli TA, Karnell LH, Graham SM, Funk GF, Buatti JM, Gupta AK, Robinson RA, Hoffman HT. J Laryngol Otol. 2009 Oct;123(10):1137-44.
Facial nerve sacrifice and radiotherapy in parotid adenoid cystic carcinoma. Iseli TA, Karnell LH, Preston TW, Graham SM, Funk GF, Buatti JM, Gupta AK, Robinson RA, Hoffman HT. Laryngoscope, 2008 Oct; 118 (10):1781-6.
