Progressão do carcinoma da glândula salivar: transformação de alto grau (adenoide cístico de baixo grau...

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ID	`RF-SALIVARY-TRANSFORMATION-PROGRESSION`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-SALIVARY`
Fontes	`SRC-ESMO-SALIVARY` `SRC-NCCN-HEAD-AND-NECK`

Origem da bandeira vermelha

Definição	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.
Direcção clínica	aguentar
Categoria	transformação-progressão

Lógica de Desencadeamento

{
  "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"
}

Notas

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).

Usado por

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