Salivary gland carcinoma progression: high-grade transformation (low-grade adenoid cystic...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-SALIVARY-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-SALIVARY`
Sources	`SRC-ESMO-SALIVARY` `SRC-NCCN-HEAD-AND-NECK`

Red Flag Origin

Definition	Salivary gland carcinoma progression: high-grade transformation (low-grade adenoid cystic / acinic cell to high-grade variant — aggressive course), perineural invasion / skull base extension on imaging (adenoid cystic dominant pattern), new lung / liver / bone metastases, rapid progression on histology-specific targeted therapy, or salivary duct carcinoma with rapidly rising tumor markers — triggers re-staging, re-biopsy with comprehensive genomic profiling, and salvage systemic therapy + RT consideration.
Clinical direction	hold
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "high_grade_transformation",
      "value": true
    },
    {
      "finding": "perineural_invasion_skull_base",
      "value": true
    },
    {
      "finding": "new_metastatic_disease",
      "value": true
    },
    {
      "finding": "rapid_progression_on_targeted_therapy",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Adenoid cystic carcinoma classically has indolent course but progressive perineural invasion + late distant relapses (lung, bone) 10-15 yr post-treatment — surveillance imaging required even in apparently "stable" patients. High-grade transformation of low-grade histologies (acinic cell, mucoepidermoid) confers worse prognosis, often requires intensified RT + cisplatin chemoradiation. Re-biopsy at progression captures actionable molecular drivers in ~30-40% (HER2, AR, NTRK, HRAS, NOTCH1) — changes salvage choice from cytotoxic to targeted. Skull-base extension may benefit from proton-beam RT (improves organ-at-risk sparing).

Used By

No reverse references found in the YAML corpus.