[Proposal for the selection and delineation of clinical target volumes for the radiotherapy of submandibular gland tumours]

[Radiotherapy of rare head and neck tumors]

Management of head and neck tumors is complex because of multiple anatomical locations and histologies possibilities. Rare tumors must be managed in a specialized center and be registered in the French network of expertise on ENT Cancers (Refcor). Despite heterogeneous levels of evidence, radiotherapy plays an essential role in their treatment. Radiation therapy is generally indicated in the adjuvant setting, or in case of non-operability. Dose and target volumes depend on histology, location and extensions of the tumor, and the quality of the excision if applicable. We present here a review of the literature and available guidelines for the management by radiotherapy of rare upper aerodigestive tract tumors.

Radiotherapy of salivary gland tumours

Primary tumours of the salivary glands account for about 5 to 10% of tumours of the head and neck. These tumours represent a multitude of situations and histologies, where surgery is the mainstay of treatment and radiotherapy is frequently needed for malignant tumours (in case of stage T3-T4, nodal involvement, extraparotid invasion, positive or close resection margins, histological high-grade tumour, lymphovascular or perineural invasion, bone involvement postoperatively, or unresectable tumours). The diagnosis relies on anatomic and functional MRI and ultrasound-guided fine-needle aspiration for the diagnostic of benign or malignant tumors. In addition to patient characteristics, the determination of primary and nodal target volumes depends on tumor extensions and stage, histology and grade. Therefore, radiotherapy of salivary gland tumors requires a certain degree of personalization, which has been codified in the recommendations of the French multidisciplinary network of expertise for rare ENT cancers (Refcor) and may justify a specialised multidisciplinary discussion. Although radiotherapy is usually recommended for malignant tumours only, recurrent pleomorphic adenomas may sometimes require radiotherapy based on multidisciplinary discussion. An update of indications and recommendations for radiotherapy for salivary gland tumours in terms of techniques, doses, target volumes and dose constraints to organs at risk of the French society for radiotherapy and oncology (SFRO) was reported in this article.