Find out about the latest UK research and clinical trials looking at salivary gland cancer.
Tests for diagnosis
One research study has been looking at using different types of MRI scans to see if they are more accurate at diagnosing salivary gland cancer. Doctors in this study are using diffusion weighted MRI (DWI) scans that help to show up damaged tissue. They are also using magnetic resonance spectroscopy (MRS) scans that look at chemical changes linked to disease in body tissues.
Intensity modulated radiotherapy (IMRT) is a newer type of radiotherapy where both the beam and the dose within the beam are shaped to match the tumour. It reduces the amount of normal tissue in the path of the radiotherapy beam. Research into using it for head and neck cancers shows that long term side effects may be less common or milder with IMRT. This type of radiotherapy treatment should now be available in every cancer network in England.
Another trial has been comparing conventional radiotherapy to IMRT for parotid gland cancer. The aim of the trial is to find out if the IMRT reduces the amount of damage to the surrounding tissues. The researchers think this will reduce the risk of hearing loss. They are also looking at whether it works as well as conventional radiotherapy.
High pressure oxygen treatment
Rarely, radiotherapy to the head and neck area can damage the jawbone. This damage is called osteoradionecrosis (pronounced oss-tee-oh-radio-neck-row-sis) or ORN. The problem develops because the radiotherapy reduces the blood supply to the area. Doctors think that a high pressure oxygen therapy called hyperbaric oxygen (HBO) may be able to stop this happening.
A trial is looking at HBO for osteoradionecrosis. Doctors think that having dental surgery can trigger the problem.
If you do develop osteoradionecrosis after radiotherapy, your doctor may suggest surgery to remove the damaged jaw bone. HBO may help the bone to heal after surgery. Doctors want to test this in a trial. Half the people taking part will have HBO before and after surgery to remove the bone. The other half will have surgery only.
Squamous cell cancer
Squamous cell cancer of the salivary gland is rare. Doctors use chemotherapy more often for squamous cell cancers than other types of salivary gland cancer. Researchers are looking into newer types of chemotherapy which may work better. These include paclitaxel and docetaxel.
Researchers are also looking into using biological therapy for squamous cell cancer of the head and neck, including salivary gland cancers. One type of biological therapy is cetuximab.
A phase 3 trial showed that people with locally advanced head and neck cancer treated with cetuximab and radiotherapy lived longer than those who just had radiotherapy. Cetuximab is now licensed to be used with radiotherapy to treat squamous cell head and neck cancers that have spread into nearby tissues.
There is a European trial looking at a treatment called electrochemotherapy to see whether it is effective in head and neck cancers.
Electrochemotherapy works in two stages. First a chemotherapy drug called bleomycin is injected into the bloodstream and a few minutes later a probe is used to send electric pulses into the tumour (electroporation). This has the effect of making the cancer cells absorb the drug more efficiently, so that treatment becomes possible with a lower dose of the chemotherapy drug.
The risk of side effects and damage to normal, healthy tissue is less.
PET-CT scans during treatment
Doctors have been trying a new way of scanning patients with head and neck cancer during treatment. They hope a combined PET-CT scan may give a better idea than other scans of how well the treatment is working.
Reducing side effects of treatment
Treatment for head and neck cancer can sometimes cause side effects that are difficult to cope with. There is information below about research into:
Treating a dry mouth
Radiotherapy to the head and neck area can cause a dry mouth. This is very uncomfortable and can make chewing, swallowing and even talking difficult. If you are making some saliva, a drug to stimulate your salivary glands may help. These include the drugs pilocarpine and bethanechol. But these drugs can cause side effects such as blurred vision, sickness and sweating in about 1 in 6 people (15%) who take them.
Recent research suggests that a drug called amifostine can help with dry mouth. This drug is a chemoprotectant, meaning that it helps to protect against the harmful side effects of chemotherapy and radiotherapy. Amifostine is still only being tested at the moment and is not a standard treatment.
Another study is looking at a medical device to stimulate the gums to increase the amount of saliva in the mouth. The researchers hope this will reduce the symptoms of dry mouth and improve quality of life.
Some studies suggest that having acupuncture may help with a dry mouth caused by head and neck radiotherapy. We need more research before we can know exactly how much it can help.
Acupuncture for pain after neck dissection
Some people who have a neck dissection operation, to remove the lymph nodes in their neck, also have their accessory nerve removed. This nerve controls shoulder movement. If it is damaged or removed, you may have a stiff and painful shoulder and neck. Your surgeon will probably suggest physiotherapy and non steroidal anti inflammatory pain killers (such as ibuprofen).
Early research in the USA suggests that acupuncture may help to relieve pain after neck dissection.
Acupuncture and moxibustion for lymphoedema
Lymphoedema is swelling caused by a build up of lymph fluid in the body. It can be a side effect of surgery or radiotherapy treatment if the lymph nodes that usually drain the fluid are removed or damaged. Lymphoedema can cause discomfort, pain and difficulty moving. There is no cure for lymphoedema, but treatments can relieve symptoms.
A small trial looked at acupuncture and moxibustion for lymphoedema. These are types of complementary therapies. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body.
In this trial, they did not put the acupuncture needles in the area affected by lymphoedema. Moxibustion uses a dried herb called mugwort which is rolled into a stick. The moxibustion practitioner holds the glowing end of the lit stick over acupuncture points to warm them.
The trial team found that acupuncture and moxibustion was safe for people with lymphoedema, especially when the needles are not put in the area of lymphoedema. The people taking part reported some improvement in their symptoms. The team suggest that more research is needed to see how much it could help improve symptoms.
Quality of life
Cancer of the minor salivary glands may be included in some trials looking at cancer of the mouth or oral cavity.
There is a trial looking at the quality of life for people who have this type of cancer.