Head & neck: Postoperative indications for concurrent chemoRT — high-risk features

Why D is correct

This patient has both high-risk features that derived a significant benefit from adding chemotherapy in the EORTC 22931/RTOG 9501 trials: a positive surgical margin and extracapsular extension. The standard of care is postoperative concurrent chemoradiotherapy with high-dose cisplatin (100 mg/m2 on days 1, 22 and 43), as reflected in the EHNS-ESMO-ESTRO guideline.

And why the others are not

• AWrong — the established postoperative high-risk regimen uses cisplatin; cetuximab is not the standard postoperative radiosensitiser.
• BWrong — surveillance would leave high-risk pathological features untreated and is inappropriate.
• CWrong — radiotherapy alone undertreats high-risk features; the addition of cisplatin gives a significant benefit here.
• EWrong — chemotherapy alone without radiotherapy is not an adequate locoregional treatment after resection of high-risk disease.

Source RTOG 9501 long-term follow-up and EORTC 22931/RTOG 9501 pooled analysis — postoperative chemoradiotherapy in high-risk head and neck cancer — Cooper JS, Zhang Q, Pajak TF, et al. Int J Radiat Oncol Biol Phys 2012 (RTOG 9501 long-term); Bernier J, Cooper JS, Pajak TF, et al. Head Neck 2005;27(10):843-850, PMID 16161069.