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For a patient with H&N squamous cell carcinoma who underwent salvage neck dissection for residual disease following primary chemoradiation with weekly cisplatin, do you offer any adjuvant therapy thereafter if extranodal extension is found?
In primary surgical resection, ENE on surgical path would be indication to add adjuvant chemoradiation. After progression through definitive chemoradiation, is there any benefit to additional radiation or chemoradiation or do you move forward with surveillance?
Answer from: Medical Oncologist at Academic Institution
Here the situation should be clarified and can be nuanced. If the initial chemoradiation was unilateral and the relapse now in the unirradiated neck, then yes, adjuvant chemoradiation is indicated (radiation alone if frail or elderly). If that relapsed neck was already radiated then adjuvant re-irra...
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Answer from: Radiation Oncologist at Community Practice
There is no primary clinical trial evidence to support or render futile salvage RT in this setting. Extracapsular extension (ECE) is certainly high-risk and the use of post-surgical RT must be carefully weighed. However, if there are positive margins, the use of RT is more understandable. We have sh...
Answer from: Medical Oncologist at Academic Institution
Unfortunately, there is no standard adjuvant therapy in this setting that has shown improvement in patient survival. Thus, adjuvant therapy cannot routinely be recommended in this setting.
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Radiation Oncologist at University of Florida
No. High risk but no re RT without positive margin...
No. High risk but no re RT without positive margin...