Postoperative radiation therapy in submandibular gland cancers

High risk requiring radiotherapy

Primary tumour bed for malignancy

  • High grade primary salivary malignancy
  • High grade mucoepidermoid
  • Salivary duct carcinoma
  • Ca ex pleomorphic
  • Adenoid cystic
  • Adenocarcinoma NOS
  • T3/4 (>4cms)
  • Perineural involvement
  • Lymphovascular invasion
  • Positive margin / close margin / tumour peeled off nerve
  • Extra-parenchymal extension
  • Recurrent disease
  • Intraoperative tumour spillage
  • Previous open / incision biopsy


  • Undissected N0 neck
  • T3/4
  • Skin/conjunctival cancer metastases to parotid
  • Dissected neck
  • >2 metastases
  • ECS

Low risk not requiring radiotherapy


  • Low grade primary salivary malignancy, completely excised
  • <4cms diameter


  • Benign tumour peeled off nerve in a well defined surgical dissection plane
  • Controlled intraoperative tumour spillage of benign tumour, with copious irrigation of the wound

Chemotherapy in the absence of radiation therapy? Current evidence does not support use of chemotherapy for salivary cancers with either curative or palliative intent. (Vander Poorten V, Meulemans J, Delaere P et al. Molecular Markers and Chemotherapy for Advanced Salivary Cancer. Curr Otorhinolaryngol Rep (2014) 2: 85.


Index: Clinical Practice Guidelines for Submandibular Gland

Resource Appropriate Submandibular Gland Guideline Scenarios