Dear Pramod,
As the submandibular carcinomas are less common overall, I don't think you would get a good data here on concurrent chemoradiation, though for unresectable cases CTRT is advisable-Ref-Jatin Shah pg 244
I'd be inclined for neoadjuvant chemo if the surgeons are open to surgery if there is tumor response to chemo and then follow it up with post op RT.
In case surgery is completely ruled out, I'd treat with CT-RT (weekly CDDP as we are comfortable with weekly than 3 weekly) and follow it up with adjuvant chemo? Adjuvant chemo decision of course need to be discussed with patient and family regarding lack of data but risk of distant metastases.
Have you spoken to pathologist for any further hints?
I wonder if you can do PET CT/ or do a PET based Treatment planning would that help in dose escalation?
pg 244 Jatin Shah——Cancer of The Head and Neck
Location is also an important factor in treatment
selection. Borderline resectable lesions in inaccessible locations,
such as sinus tumors involving the
base of the skull, may be better suited for nonsurgi-
cal therapy such as chemoradiotherapy or neutron
beam irradiation. When resection margins are close
because of tumor proximity to vital structures, the
evidence suggests that adjunctive radiotherapy can
improve results.
Histology may influence treatment planning as
well. Adenoid cystic carcinoma, for example, with
its propensity for perineural spread and insidious
local extension, is often very difficult to ade-
quately encompass with surgical resection alone.
Other lesions that are high grade histologically
more often present with locally extensive disease,
and also have a higher incidence of distant metas-
tases than their low grade counterparts, which sug-
gests the need for effective systemic therapy in this
subset of patients.
pg 244 Jatin Shah——Cancer of The Head and Neck
