Radiotherapy for salivary gland cancer: REFCOR recommendations by the formal consensus method

Objective: To determine the indications for radiotherapy in salivary gland cancer and to specify the modalities and target radiation volumes. Material and methods: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Results: Postoperatively, radiotherapy to the primary tumor site ± to the lymph nodes is indicated if one or more of the following adverse histoprognostic factors are present (risk > 10% of locoregional recurrence): T3–T4 category, lymph node invasion, extraglandular invasion, close or positive surgical margins, high tumor grade, perineural invasion, vascular emboli, and/or bone invasion. Intensity-modulated radiation therapy (IMRT) is the gold standard. For unresectable cancers or inoperable patients, carbon ion hadrontherapy may be considered. Conclusion: Radiotherapy in salivary gland cancer is indicated in postoperative situations in case of adverse histoprognostic factors and for inoperable tumors.