Adenoid Cystic Carcinoma of the Salivary Gland — What to Do After Surgical Resection
Clinical scenario
This protocol applies to patients with adenoid cystic carcinoma (ACC) of the salivary gland who have undergone surgical resection of the primary tumour. The central clinical question is how to manage these patients in the postoperative period to reduce the risk of locoregional recurrence.
Prior treatment & why this step follows
The preceding intervention was open surgical excision of the adenoid cystic carcinoma, with the primary goal of achieving negative surgical margins and facial nerve preservation where feasible. Reaching clear margins at surgery is the critical threshold; this protocol defines the next management step that follows resection.
Postoperative approach (partial overview)
Following resection, postoperative radiation therapy is indicated for all patients with ACC. The field coverage is guided by the surgical bed and relevant nodal anatomy, and is further shaped by specific intraoperative findings — including the status of perineural involvement. Full dosing targets, field definitions, timing requirements, and management of perineural spread toward the skull base are detailed in the structured protocol
References
DOI: 10.1200/JCO.21.00449
- Postoperative RT should be offered to all patients with resected ACC.
- Postoperative radiation therapy (RT) should be offered to all patients with resected adenoid cystic carcinoma (ACC).
- Postoperative radiotherapy when conventionally fractionated should be at least 60 Gy to the high-dose target.
- Radiation should be initiated within 8 weeks of surgery.
- In the case of perineural invasion, the associated nerve(s) may be covered with an elective or intermediate dose to the skull base.
- Coverage of the involved nerve to the base of skull with an elective or intermediate dose (46–54 Gy in 2 Gy fractions) may be reasonable to reduce the risk of retrograde nerve failure toward the base of skull.
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