Skip to main content
Medicine LibreTexts

6.9.13: 13. Indications for Postoperative (chemo)radiation Therapy

  • Page ID
    53890
  • \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)

    Oropharyngeal cancer: Indications for postoperative (chemo)radiation therapy

    Postoperative Radiotherapy

    • Ideally commenced within 6 weeks of surgery
    • Primary tumour bed
      • T3/4
      • Perineural invasion (PNI)
      • Positive / close margin
      • Intra-operative tumour spillage
      • Bone marrow invasion
      • Note: Lymphovascular invasion is more an indication of risk for spread to nodes rather than for recurrence and so it is not an indication on its own for adjuvant RT
    • Neck
      • >2 metastatic nodes
      • Extranodal extension (ENE)

    Postoperative Chemoradiation

    Indications

    • Positive margins
    • ENE

    Added expense and toxicity

    • Only 5% lifetime survival advantage with addition of chemotherapy to radiation therapy in an adjuvant setting
    • Therefore carefully consider indications especially in
      • Poor patient
      • Poor socioeconomic support
      • Poor general health
      • Elderly