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Head and Neck SCC — SCE Medical Oncology MCQ

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ModerateHead & Neck CancerHead and Neck SCCSCE Medical Oncology

A 58-year-old man with head and neck SCC (oral cavity, T4a N2b M0) undergoes composite resection with free flap reconstruction and bilateral neck dissection. Final pathology shows 5 positive nodes with extranodal extension but clear margins. What adjuvant therapy is required?

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Correct answer: B — Concurrent cisplatin (100 mg/m² 3-weekly) chemoradiotherapy

Extranodal extension (ENE) after primary surgery for HNSCC is the strongest indication for adjuvant concurrent cisplatin chemoradiotherapy (EORTC 22931/RTOG 9501). Even with clear margins, ENE mandates combined modality adjuvant treatment. Three-weekly cisplatin 100 mg/m² is the standard radiosensitising regimen. Cetuximab-RT is inferior to cisplatin-RT for adjuvant treatment. The cumulative cisplatin dose target is ≥200 mg/m² over the RT course for optimal benefit.

Reference: NICE NG36 Cancer of the upper aerodigestive tract; EORTC 22931 Bernier et al NEJM 2004; RTOG 9501 Cooper et al NEJM 2004