Treatment

The treatment of AdCC depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the clinical trials section.

Surgery

Surgical removal of the tumor is the best treatment for AdCC, provided it can be done safely and is likely to have a good outcome. During surgery, the surgeon will remove the tumor and an area of tissue surrounding it, called a margin. If the margin removed during surgery is found to be “clean”, meaning at least 2 millimeters (mm) of tissue that is cancer-free surrounding the tumor, this signals total tumor removal and gives the best chance for successful treatment at the site of origin.

Side effects from surgery vary depending upon the surgical site. A concern with all surgeries of the parotid gland is that the surgery may damage or sever facial nerves, which can cause the muscles in the face to droop. Sometimes, a facial nerve graft may be used to restore function of the facial muscles after surgery to remove the tumor. The extent of surgery will vary by the site of the tumor and the structures that are involved.

External-beam radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy is particularly effective as an adjuvant therapy (therapy given in addition to the primary treatment) after surgery by helping to eliminate any microscopic cancer cells remaining in the body after surgery. Radiation therapy is not used pre-operatively (before surgery) for this disease, as many surgeons feel that the surgical wound heals better if radiation therapy is not given prior to surgery.

A specific method of external-beam radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects.

Since radiation therapy is targeted to a specific area, the side effects will depend on where the radiation therapy was given. Generally, during head and neck treatments, people may experience a sore mouth and/or throat that can cause pain and difficulty in swallowing. They may also have a skin reaction or burn that causes some pain. Because of the effects of radiation therapy on normal tissues, especially around the mouth and throat, patients are encouraged to receive prophylactic (preventive) care by a dentist trained in oncology before treatment begins.

Long-term side effects of radiation therapy vary with the sites involved, but they may include permanent loss of saliva causing dryness of the mouth and deterioration of the teeth. In some cases, a drug to stimulate the parotid saliva gland and increase or restore saliva levels may be given. Currently, amifostine (Ethyol), a drug to protect tissues during radiation therapy is being studied. Scarring or fibrosis (hardening or thickening) of the skin and muscles may develop several months to years after radiation therapy and lead to problems with wound healing, neck stiffness, and trouble swallowing. Other long-term effects that can develop include accelerated narrowing of the carotid arteries (the arteries that supply the head and neck with blood) and hypothyroidism (underactive thyroid disease).

Patients are encouraged to meet with a qualified speech pathologist prior to radiation therapy, so appropriate exercises can be performed to maintain the strength and flexibility of the muscles used during speech and swallowing.

Neutron and proton radiation therapy

Neutron therapy is a different form of radiation therapy. Compared with conventional radiation therapy, neutrons can deliver 20 times to 100 times more energy along their path length, causing much greater damage to the cancer cells. Neutron radiation therapy has been tested on many different types of tumors, with salivary gland tumors and, in particular, AdCC showing the greatest benefit. In certain instances, it may be the treatment of choice for AdCC, particularly in areas of the body where it is difficult to perform surgery. However, neutron therapy carries more severe side effects than conventional radiation therapy, such as severe sore mouth and/or throat and difficulty swallowing, and is therefore generally used more often with people with inoperable or recurrent disease. Medication to help increase saliva production and protect tissues may be given during this treatment. Neutrons cannot be used to treat large areas of the body for metastatic disease, but they can be used to treat isolated metastases that are causing problems, such as pain, blocking part of the lung, or pressing on the spinal cord.

A new type of radiation is proton therapy. Proton therapy acts similarly to traditional radiation therapy to kill cancer cells. The advantage of proton therapy is the ability to better control where the radiation is delivered, greatly reducing the damage to normal healthy tissues that surround the tumor. However, proton therapy has not been extensively investigated for use in AdCC.

Neither neutron nor proton therapy is widely available. Talk with your doctor for information about availability of these treatments.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is generally not used for AdCC, as this type of cancer appears to be less responsive to chemotherapy than other types of cancer. Various combinations of chemotherapy have been used to treat AdCC, without much success. The combination of chemotherapy and radiation therapy is considered experimental for AdCC.

Because AdCC is a rare disease, and, in general, the current chemotherapy is of limited benefit, it is recommended that people with AdCC ask about clinical trials to treat this disease. A second opinion at a cancer center may also be beneficial.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.