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Head & neck: Postoperative indications for concurrent chemoRT

Free question published 24 August 2026

Head & neckPostoperative indications for concurrent chemoRT

A 63-year-old man has undergone resection of a pT3 oral cavity squamous cell carcinoma with a selective neck dissection. Histology shows clear margins (closest 6 mm), no perineural or lymphovascular invasion, but two of 28 nodes are involved with no extracapsular spread. He is fit, with normal renal function. The multidisciplinary team plans adjuvant treatment. Which option is best supported by the evidence?

  1. AAdjuvant radiotherapy alone, as concurrent cisplatin adds benefit only when there is extracapsular extension and/or positive margins
  2. BConcurrent chemoradiotherapy with cisplatin, because two involved nodes is an absolute indication for adding chemotherapy
  3. CObservation, since clear margins and absence of extracapsular spread mean no adjuvant treatment is required
  4. DAdjuvant cetuximab with radiotherapy as the preferred chemoradiosensitiser in the postoperative setting
  5. ERe-resection to widen the margins before any adjuvant therapy

Why A is correct

In the pooled EORTC 22931/RTOG 9501 analysis (Bernier 2005), extracapsular extension and/or microscopically involved margins were the only features for which adding concurrent cisplatin to postoperative radiotherapy gave a significant benefit; patients with multiple involved nodes alone (without ECE) did not benefit from added chemotherapy. With clear margins, no extracapsular spread and adverse features warranting radiotherapy (pT3, nodal disease), adjuvant radiotherapy alone is the appropriate choice.

And why the others are not

  • BWrong — multiple involved nodes without extracapsular extension did not derive a significant chemotherapy benefit in the pooled analysis.
  • CWrong — pT3 disease with nodal involvement warrants adjuvant radiotherapy; observation alone would undertreat him.
  • DWrong — postoperative high-risk chemoradiotherapy uses cisplatin, not cetuximab; cetuximab is not the standard postoperative radiosensitiser.
  • EWrong — margins are clear at 6 mm, so re-resection is not indicated.

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.

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