Distant Metastases and Palliative Care

Salivary gland neoplasms are rare and diverse tumors with variable disease courses, making it difficult to concisely summarize the management of distant metastases (DM). Nonetheless, there are trends of DM in salivary gland cancer that can be contextualized and reviewed. In general, the primary tumor characteristics that predict DM include the primary tumor site, tumor stage and grade, perineural spread, cervical nodal status, and genomic signatures. The most common site of DM is the lung, followed by the bone, liver, and brain. Depending on the clinical presentation, DM can be treated with watchful waiting, local therapies (surgery and/or radiation), or systemic therapy (cytotoxic or targeted chemotherapy). In general, DM confer a poor prognosis, and any cancer-directed treatment options should be carefully considered in the context of specific goals of care, symptom burden, and patient preference.