RT Book, Section
A1 Rowe, Julie H.
A1 Gonzalez, Anneliese O.
A1 Jafri, Syed H.
A1 Cen, Putao
A1 Kanaan, Zeyad
A1 Amato, Robert J.
A1 Rios, Adan
A1 El-Osta, Hazem
A1 Mohlere, Virginia
SR Print(0)
ID 1162981221
T1 Head and Neck Cancer
T2 Hematology-Oncology Clinical Questions
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 978-1-260-02662-7
LK hemonc.mhmedical.com/content.aspx?aid=1162981221
RD 2024/04/23
AB Table  Graphic  Jump  Location|Download  (.pdf)|PrintKey  conceptDisease  recurrence  is  a  major  problem  in  resected  advanced  head  and  neck  cancer.  The  addition  of  radiation  treatment  after  surgical  resection  can  reduce  the  risk  of  locoregional  relapse.  The  addition  of  chemotherapy  may  further  reduce  that  risk  and  improve  outcomes  in  specific  settings.Clinical  scenarioA  53-year-old  man  is  post  laryngectomy  and  left  neck  dissection  for  locally  advanced  laryngeal  squamous  cell  carcinoma.  His  surgical  pathology  revealed  positive  margins,  and  2  of  16  lymph  nodes  were  positive  for  metastatic  disease  with  presence  of  extracapsular  extension  (ECE).  What  adjuvant  treatment  should  he  receive?Action  itemsCisplatin  is  the  drug  of  choice  in  the  adjuvant  setting.  Cisplatin  can  be  administered  either  weekly  (40  mg/m2)  or  every  3  weeks  (100  mg/m2),  concurrently  with  adjuvant  radiation.  The  role  of  cetuximab  in  the  adjuvant  setting  remains  investigational.Chemotherapy  strongly  recommendedPositive  surgical  marginECE  of  nodal  diseaseChemotherapy  to  be  consideredPathologic  N2/N3  diseasePathologic  T3/T4  diseasePresence  of  perineural  invasionPresence  of  lympho-vascular  invasionDiscussionThe  RTOG95-01  trial,  a  randomized  controlled  study  comparing  adjuvant  radiation  to  combined  adjuvant  cisplatin  and  radiation  in  patients  with  resected  locally  advanced  HNSCC,  revealed  that  in  subgroups  of  patients  with  ECE  or  positive  surgical  margins,  the  locoregional  failure  rate  (LRF)  and  disease-free  survival  at  10  years  were  significantly  in  favor  of  the  chemoradiation  arm.  There  were  a  trend  toward  improvement  in  overall  survival  (OS)  in  that  study  arm  as  well.1  Similarly,  the  EORTC-22931  study  enrolled  patients  with  resected  HNSCC  with  high-risk  features,  including  positive  surgical  margins,  ECE,  pathologic  N2/N3  or  T3/T4  stage,  perineural  involvement,  and  vascular  tumor  embolism.  Concurrent  high-dose  cisplatin  and  radiation  improved  progression-free  survival  and  OS  and  lowered  LRF  compared  with  adjuvant  radiation  only.2PearlsThe  addition  of  cisplatin  concurrently  with  radiation  improves  clinical  outcome  in  patients  with  high-risk  features  (and  is  strongly  recommended  in  patients  with  ECE  or  positive  margins),  at  the  expense  of  increased  toxicities.ReferencesCooper  JS,  Zhang  Q,  Pajak,  TF,  et  al.  Long-term  follow-up  of  the  RTOG  9501/intergroup  phase  III  trial:  postoperative  concurrent  radiation  therapy  and  chemotherapy  in  high-risk  squamous  cell  carcinoma  of  the  head  and  neck.  Int  J  Radiat  Oncol  Biol  Phys  2012;84(5):1198-205.Bernier  J,  Domenge  C,  Ozsahin  M,  et  al.  Postoperative  irradiation  with  or  without  concomitant  chemotherapy  for  locally  advanced  head  and  neck  cancer.  N  Engl  J  Med  2004;350(19):1945-52.