Postoperative radiation therapy in the management of head and neck cancer
- Shruti Jolly, MD
Shruti Jolly, MD
- Assistant Professor
- University of Michigan Health System
- Avraham Eisbruch, MD
Avraham Eisbruch, MD
- Professor and Associate Chair for Clinical Research
- Department of Radiation Oncology
- University of Michigan
- Francis P Worden, MD
Francis P Worden, MD
- Department of Internal Medicine
- Division of Hematology and Oncology
- University of Michigan
- Richard Smith, MD
Richard Smith, MD
- Professor and Vice-Chair, Otorhinolaryngology-Head and Neck Surgery
- Albert Einstein College of Medicine, Montefiore Medical Center
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Selected high-risk patients with head and neck squamous cell carcinoma receive postoperative radiation therapy (RT), with or without concurrent chemotherapy, following primary surgical resection with the aim of improving locoregional control and survival. The rationale for this approach is that RT may eradicate microscopic deposits of cancer cells that would progress and lead to a locoregional recurrence.
The role of postoperative RT for head and neck cancer, usually given with concurrent chemotherapy, will be reviewed here. Other relevant topics include:
Subscribers log in hereLiterature review current through: Aug 2017. | This topic last updated: Aug 02, 2017.References
- Bernier J, Cooper JS. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence? Oncologist 2005; 10:215.
- Jacobs JR, Ahmad K, Casiano R, et al. Implications of positive surgical margins. Laryngoscope 1993; 103:64.
- Laramore GE, Scott CB, Schuller DE, et al. Is a surgical resection leaving positive margins of benefit to the patient with locally advanced squamous cell carcinoma of the head and neck: a comparative study using the intergroup study 0034 and the Radiation Therapy Oncology Group head and neck database. Int J Radiat Oncol Biol Phys 1993; 27:1011.
- Rosenthal DI, Mohamed ASR, Garden AS, et al. Final Report of a Prospective Randomized Trial to Evaluate the Dose-Response Relationship for Postoperative Radiation Therapy and Pathologic Risk Groups in Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2017; 98:1002.
- Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck 2005; 27:952.
- Jäckel MC, Ambrosch P, Christiansen H, et al. Value of postoperative radiotherapy in patients with pathologic N1 neck disease. Head Neck 2008; 30:875.
- Sinha P, Lewis JS Jr, Piccirillo JF, et al. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer 2012; 118:3519.
- Maxwell JH, Ferris RL, Gooding W, et al. Extracapsular spread in head and neck carcinoma: impact of site and human papillomavirus status. Cancer 2013; 119:3302.
- Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350:1945.
- Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350:1937.
- Cooper JS, Zhang Q, Pajak TF, et al. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2012; 84:1198.
- Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005; 27:843.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Bachaud JM, Cohen-Jonathan E, Alzieu C, et al. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996; 36:999.
- Franchin G, Minatel E, Politi D, et al. Postoperative reduced dose of cisplatin concomitant with radiation therapy in high- risk head and neck squamous cell carcinoma. Cancer 2009; 115:2464.
- Harari PM, Harris J, Kies MS, et al. Postoperative chemoradiotherapy and cetuximab for high-risk squamous cell carcinoma of the head and neck: Radiation Therapy Oncology Group RTOG-0234. J Clin Oncol 2014; 32:2486.
- Racadot S, Mercier M, Dussart S, et al. Randomized clinical trial of post-operative radiotherapy versus concomitant carboplatin and radiotherapy for head and neck cancers with lymph node involvement. Radiother Oncol 2008; 87:164.
- Kies MS, Harris J, Rotman MZ, et al. Phase II Randomized Trial of Postoperative Chemoradiation Plus Cetuximab for High-risk Squamous Cell Carcinoma of the Head and Neck (RTOG 0234). Int J Radiat Oncol Biol Phys 2009; 75:S14 http://www.redjournal.org/article/S0360-3016(09)01099-2/fulltext (Accessed on July 28, 2014).
- Kokal WA, Neifeld JP, Eisert D, et al. Postoperative radiation as adjuvant treatment for carcinoma of the oral cavity, larynx, and pharynx: preliminary report of a prospective randomized trial. J Surg Oncol 1988; 38:71.
- Mishra RC, Singh DN, Mishra TK. Post-operative radiotherapy in carcinoma of buccal mucosa, a prospective randomized trial. Eur J Surg Oncol 1996; 22:502.
- Lavaf A, Genden EM, Cesaretti JA, et al. Adjuvant radiotherapy improves overall survival for patients with lymph node-positive head and neck squamous cell carcinoma. Cancer 2008; 112:535.
- Huang DT, Johnson CR, Schmidt-Ullrich R, Grimes M. Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: a comparative study. Int J Radiat Oncol Biol Phys 1992; 23:737.
- Lundahl RE, Foote RL, Bonner JA, et al. Combined neck dissection and postoperative radiation therapy in the management of the high-risk neck: a matched-pair analysis. Int J Radiat Oncol Biol Phys 1998; 40:529.
- Ang KK, Trotti A, Brown BW, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 51:571.
- Mantravadi RV, Haas RE, Liebner EJ, et al. Postoperative radiotherapy for persistent tumor at the surgical margin in head and neck cancers. Laryngoscope 1983; 93:1337.
- Parsons JT, Mendenhall WM, Stringer SP, et al. An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity. Int J Radiat Oncol Biol Phys 1997; 39:137.
- Peters LJ, Goepfert H, Ang KK, 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; 26:3.
- Awwad HK, Lotayef M, Shouman T, et al. Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation. Br J Cancer 2002; 86:517.
- Shah N, Saunders MI, Dische S. A pilot study of postoperative CHART and CHARTWEL in head and neck cancer. Clin Oncol (R Coll Radiol) 2000; 12:392.
- Trotti A, Klotch D, Endicott J, et al. A prospective trial of accelerated radiotherapy in the postoperative treatment of high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 1993; 26:13.
- Chao KS, Emami B, Akhileswaran R, et al. The impact of surgical margin status and use of an interstitial implant on T1, T2 oral tongue cancers after surgery. Int J Radiat Oncol Biol Phys 1996; 36:1039.
- Beitler JJ, Smith RV, Silver CE, et al. Close or positive margins after surgical resection for the head and neck cancer patient: the addition of brachytherapy improves local control. Int J Radiat Oncol Biol Phys 1998; 40:313.
- Marcial VA, Pajak TF, Kramer S, et al. Radiation Therapy Oncology Group (RTOG) studies in head and neck cancer. Semin Oncol 1988; 15:39.
- APPROACH TO POSTOPERATIVE MANAGEMENT
- POSTOPERATIVE CHEMORADIATION
- Chemoradiotherapy versus radiotherapy alone
- Concurrent chemotherapy regimen
- - Platinum-based chemotherapy
- - Cetuximab
- - Docetaxel
- POSTOPERATIVE RT ALONE
- Initiation and treatment delays
- Dose and treatment volume
- Radiotherapy techniques
- Postoperative versus preoperative RT
- SUMMARY AND RECOMMENDATIONS