Post-operative Therapy

Recurrence after Surgery

Recurrence1.jpg

Radiation Alone

Indications (per NCCN and RPA analysis)[2]

  • Perineural invasion
  • Lymphovascular invasion
  • T3/T4 may be an indication for CRT or RT alone

Dose

  • 57.6 Gy to whole operative bed with a boost of 63 Gy to sites of increased risk. [1]

Chemoradiation

Indications (per NCCN and RPA analysis)[2]

  • Extracapular extension
  • Close or positive margin
  • 2 more more positive lymphnodes
  • T3/T4 may be an indication for CRT or RT alone

Treatment

  • Start treatment 4-6 weeks after surgery and no later than 8 weks
  • 60 Gy in 30 fractions with or without 6 Gy boost to high-risk areas
  • Cisplatin 100 mg/mg/m2 IV on days 1, 22, and 43.

Results of RTOG 95-01

Site of Failure at 5-years CRT RT p-value
Local 16% 29% < 0.01
Distant 20% 23% 0.46
  • Combined modality had a significant DFS advantage at 5 years with 45 month vs 32 month median survival advantage.
  • more acute toxicity especially mucositis and esophagitis as well as hematologic but not more chronic toxicity
Bibliography
1. Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, Morrison WH, Weber RS, Garden AS, Frankenthaler RA, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):3-11.
2. Langendijk JA, Slotman BJ, van der Waal I, Doornaert P, Berkof J, Leemans CR. Risk-group definition by recursive partitioning analysis of patients with squamous cell head and neck carcinoma treated with surgery and postoperative radiotherapy. Cancer. 2005 Oct 1;104(7):1408-17.
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