From the Guidelines
The recommended postoperative adjuvant therapy for high-risk head and neck cancer patients is concurrent chemoradiotherapy with cisplatin, as it has been shown to improve locoregional control and disease-free survival in patients with extracapsular nodal spread and/or positive resection margins 1. This approach is supported by the results of two multicenter randomized trials, RTOG 9501 and EORTC 22931, which demonstrated a significant benefit of adding cisplatin to postoperative radiation therapy in patients with high-risk features 1. The NCCN guidelines recommend adjuvant chemoradiotherapy for patients with extracapsular nodal spread and/or positive surgical margins, and consider chemoradiation for patients with other adverse risk factors, such as multiple positive nodes, vascular/perineural invasion, and pT4 primary tumors 1. Key points to consider when implementing this approach include:
- Radiation therapy should be administered at a dose of 60-66 Gy over 6-7 weeks
- Cisplatin should be administered at 100 mg/m² every 3 weeks for a total of 3 cycles, or alternatively, weekly cisplatin at 40 mg/m² during radiation
- Treatment should begin within 6 weeks of surgery for optimal outcomes
- Close monitoring for toxicities, including mucositis, dermatitis, dysphagia, neutropenia, and nephrotoxicity, is essential during treatment
- For patients who cannot tolerate cisplatin, alternatives such as carboplatin or cetuximab may be considered 1.
From the FDA Drug Label
- 1 Squamous Cell Carcinoma of the Head and Neck (SCCHN) ERBITUX® is indicated: in combination with radiation therapy for the initial treatment of locally or regionally advanced squamous cell carcinoma of the head and neck (SCCHN). The recommended postoperative adjuvant therapy for patients with high-risk features after surgery for head and neck cancer is not explicitly stated in the provided drug labels.
- The labels discuss the use of cetuximab in combination with radiation therapy for the initial treatment of locally or regionally advanced squamous cell carcinoma of the head and neck (SCCHN) 2, but do not provide information on postoperative adjuvant therapy.
- Therefore, no conclusion can be drawn regarding the recommended postoperative adjuvant therapy for patients with high-risk features after surgery for head and neck cancer.
From the Research
Postoperative Adjuvant Therapy for Head and Neck Cancer
The recommended postoperative adjuvant therapy for patients with high-risk features after surgery for head and neck cancer includes:
- Postoperative concurrent chemoradiotherapy (CCRT) with cisplatin-based chemotherapy, which has been shown to improve locoregional control (LRC) and disease-free survival (DFS) in patients with high-risk features such as extracapsular extension (ECE) of nodal disease 3, 4, 5.
- The use of CCRT has been demonstrated to improve overall survival (OS) in patients with high-risk features, particularly those with ECE 3, 4.
- Radiation therapy (RT) alone may not be sufficient for patients with high-risk features, and the addition of chemotherapy has been shown to improve outcomes 3, 4, 5.
High-Risk Features
High-risk features in patients with resected head and neck cancer include:
- Extracapsular extension (ECE) of nodal disease, which has been confirmed as a high-risk pathological feature negatively influencing LRC and survival 3, 4.
- Positive margins, which are also associated with a higher risk of recurrence and poorer outcomes 4.
Treatment Options
Treatment options for patients with high-risk features after surgery for head and neck cancer include:
- Postoperative CCRT with cisplatin-based chemotherapy, which is considered the standard of care for patients with high-risk features 3, 4, 5.
- Radiation therapy (RT) alone, which may be considered for patients who are not candidates for CCRT 4.
- Targeted therapy or immunotherapy, which may be considered in combination with RT for patients with specific tumor characteristics or comorbidities 6.