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12. Indications for Postoperative (Chemo)Radiation Therapy

  • Page ID
    18416
  • Postoperative Radiotherapy

    • Should be commenced within 6 weeks of surgery
    • Primary tumour bed
      • T3/4
      • Perineural invasion: PNI of nerves > 0.1mm upstaged to pT3 (AJCC 8th Ed 2017)
      • Lymphovascular invasion
      • Positive margin / close margin
      • Intraoperative tumour spillage
      • Significant bone destruction
      • Bone marrow invasion
    • Neck
      • >2 metastases
      • Extracapsular spread (ECS)

    Postoperative chemoradiation

    • Indications
      • Positive margins
      • ECS
    • Added expense and toxicity of chemoradiation
      • Only 4% lifetime survival advantage by addition of chemotherapy to radiation therapy in an adjuvant setting
      • Therefore carefully consider indications especially in
        • Poor patient
        • Poor socioeconomic support
        • Poor general health
        • Aged