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


  • 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

Index: Clinical Practice Guidelines for Oropharyngeal Cancer

Resource Appropriate Oropharyngeal Cancer Guideline Scenarios