Indications for Postoperative (Chemo)radiation Therapy with Oral Cancer

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

Index: Clinical Practice Guidelines for Oral Cancer

Resource Appropriate Oral Cancer Guideline Scenarios