Submandibular gland cancer
ICD-10 C08.0 · ICD-11 2B68&XA9Q61

Treatment of Submandibular Gland Cancer When Surgery Is Not an Option Due to Comorbidities or Functionally Unresectable Disease

A subset of patients with submandibular gland cancer present with disease that cannot be surgically removed — either because the tumour itself is functionally unresectable, or because the patient's comorbidities make them unsuitable for an operative procedure. When distant spread is absent (M0), the clinical priority shifts to achieving locoregional control through a non-surgical primary approach.

Clinical scenario

Functionally unresectable submandibular gland cancer, or resection precluded by comorbidities — without distant metastasis (M0). Curative-intent treatment remains possible in this setting.

Curative primary radiotherapy is the indicated approach for patients with functionally unresectable disease or who are unsuitable for surgery due to comorbidities [IV, B].

Treatment approach (partial overview)

The standard strategy centres on curative-intent primary radiotherapy — delivered with modern photon-based techniques to the primary site and relevant nodal regions, including elective neck coverage. An alternative particle-based approach exists for selected cases.

Full regimen details — specific technique selection, dose fractionation, field design, and sequencing — are available in the complete structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.esmoop.2022.100602

Curative primary RT is indicated for patients with functionally unresectable disease or who are unsuitable for surgery due to comorbidities [IV, B].

Primary IMRT/VMAT photon RT up to 35 x 2 Gy to the primary tumour and positive neck nodes with ENI with equal indications as for primary surgery may result in ~50% locoregional control [IV, B].

In most institutes, primary photon therapy up to 70 Gy is still applied.

Primary particle treatment, namely C12, may result in higher locoregional control rates compared with photon RT (but with limited availability) [IV, C].

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