Radiotherapy of salivary gland tumours: 2025 update

Salivary gland tumours are relatively common among rare tumors and encompass both benign (mostly) and malignant entities (not to be initially misdiagnosed). Early diagnosis and appropriate management are crucial determinants of prognosis. The treatment of malignant tumours is guided by their wide histological diversity and grading, each requiring specific therapeutic strategies. Surgical resection remains the standard of care, with ipsilateral neck dissection recommended for intermediate- or high-grade malignancies. Postoperative radiotherapy is indicated for high-grade tumours, pT3 or higher stages, positive surgical margins, or lymph node involvement. In cases with extensive perineural invasion, particularly in adenoid cystic carcinoma, inclusion of the affected nerve pathways in the radiation field should be considered. Benign salivary gland tumours generally do not require radiotherapy, though its use may be discussed in selected cases of multirecurrent pleomorphic adenoma, where management remains controversial. This article summarizes and updates the recommendations of the Société française de radiothérapie oncologique (the French society for radiation oncology) regarding the indications and technical aspects of radiotherapy for salivary gland tumours, with emphasis on fractionation schedules, target volume delineation, and organ-at-risk sparing.