Does a patient with a 3mm squamous cell carcinoma (scc) of the lower lip, who is a heavy smoker (T2), require adjuvant radiation therapy (adj rt) after resection with clear margins, no lymphovascular invasion (lvi), no perineural invasion (pni), and a normal computed tomography (ct) scan of the neck?

From the Guidelines

Adjuvant radiotherapy (RT) is not recommended for this patient with a T2 squamous cell carcinoma (SCC) of the lower lip that has been completely resected with clear margins, no lymphovascular invasion (LVI), no perineural invasion (PNI), and normal CT findings of the neck, as the margin is only 3mm but still considered clear and there are no other high-risk features present 1. The patient's tumor characteristics, including a small tumor size (T2) and lack of aggressive features such as LVI, PNI, or nodal involvement, suggest a low risk of recurrence.

• The absence of high-risk features such as close or positive margins (< 5mm is considered close but 3mm is still considered clear in some contexts), extracapsular spread, or nodal involvement supports the decision not to recommend adjuvant RT 1.
• Close clinical follow-up is appropriate for this patient, rather than adjuvant RT, to monitor for any signs of recurrence or new suspicious lesions.
• The decision to forego adjuvant RT is based on the favorable pathologic features of the resected tumor and the potential for radiotherapy to cause unnecessary morbidity, including mucositis, xerostomia, and fibrosis, in a patient with already adequate local control 1.
• Follow-up should include regular clinical examinations every 2-3 months for the first two years, then every 3-6 months for years 3-5, with reimaging and consideration of further treatment, including possible radiotherapy, if concerning features arise during follow-up.

From the Research

Prognostic Factors for Rectal Cancer

• Lymphovascular invasion (LVI) and perineural invasion (PNI) are significant prognostic factors for rectal cancer, as shown in studies 2, 3, 4, 5, 6
• The presence of LVI or PNI is associated with decreased survival rates and increased risk of recurrence in rectal cancer patients 2, 3, 4, 5, 6

Adjuvant Therapy for Rectal Cancer

• Adjuvant chemotherapy may be beneficial for patients with PNI, as it can reduce the distant failure rate in these patients 4
• The status of PNI, rather than LVI, could be an indicator for identifying patients who could benefit from adjuvant systemic chemotherapy 4

Specific Case Consideration

• For a T2 smoker with 3mm squamous cell carcinoma (scc) of the lower lip, resected with clear margin, and no lymphovascular invasion (LVI) or perineural invasion (PNI), the need for adjuvant radiotherapy (adj rt) is not directly addressed by the provided studies, which primarily focus on rectal cancer
• However, the absence of LVI and PNI in this case may suggest a lower risk of recurrence, but the decision for adjuvant therapy should be based on individual patient factors and clinical guidelines specific to head and neck cancers, rather than rectal cancer studies 2, 3, 4, 5, 6

Head and Neck Cancer Considerations

• The provided studies do not directly address the management of head and neck cancers, such as squamous cell carcinoma of the lower lip
• The decision for adjuvant radiotherapy in this case should be based on factors such as tumor size, depth of invasion, margin status, and presence of other high-risk features, as well as clinical guidelines specific to head and neck cancers, rather than the studies on rectal cancer provided 2, 3, 4, 5, 6