1. Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer Claus Rödel Department of Radiation Therapy University of Frankfurt

2. Prognostic factors for locoregional control T stage (T1/2 better than T3/4) Resection margin status Tumor site (oral better than other sites) Bone invasion Perineural invasion Treatment modality (OP+RT better OP) Not the histologic type!? Therhaard et al. Head Neck 2004

3. Postoperative RT recommended for: pT3/4 or pN+ Close (≤5mm) or incomplete (<1mm) resection Bone invasion Perineural invasion Recurrent tumors

4. Risk of positive neck nodes Histologic type T stage (T1:15%, T2:25%, T3/4:33%) Tumor location

5. Risk of positive neck nodes High risk: Squamous cell Undifferentiated Salivary duct Intermediate risk: Mucoepidermoid Low risk: Acinic cell Adenoid cystic Carcinoma ex pleomorphic adenoma HISTOLOGYHISTOLOGY

6. Risk estimation for positive neck nodes Total score (T stage + histologic type Parotid gland (%) Submandib. gland (%) Oral cavity (%) 2404 3123313 4255719 53360- 63850- T1 = 1; T2 = 2; T3/4 = 3 Acinic or adenoid cystic or carcinom ex pleomorhic adenoma = 1 Mucoepidermoid = 2 Squamous cell or undifferentiated = 3 Terhaard et al., IJROBP 2007

7. Elective treatment of neck nodes recommended for: Parotid tumors for a score ≥ 4: Level Ib -III Submandibular tumors: except for T1 acinic or adenoid cystic carcinoma: Level I-III Minor salivary gland tumors: tumors in the tongue, floor of the mouth, pharynx or larynx In case of pN+: homolateral level I-V

8. CRITICAL POINTS FOR RT : Clinical Target Definition 3D-conformal, IMRT High-LET (neutron, ions)? Concurrent Chemotherapy or targeted therapy?