There are insufficient data to support the routine use of adjuvant or neoadjuvant chemotherapy. Chemotherapy should be reserved for the palliation of disease-related symptoms and for patients at risk of developing such symptoms due to rapid progression of locally recurrent or metastatic disease. In patients with indolent disease and without symptoms, watchful waiting is acceptable, and may be the preferred approach. The different histological subtypes of malignant tumors of salivary gland origin may have differing responsiveness to chemotherapeutic agents. The published literature on the role of systemic therapy in malignancies of the salivary glands is inadequate and limits the generation of evidence-based recommendations. All patients should be considered for participation in clinical trials to help define the role of systemic therapies in these tumors. As the understanding of the underlying molecular abnormalities of these tumors grows, there will be opportunities for the development and testing of novel, targeted agents.
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