A 60-year-old male with T3N2bM0 squamous cell carcinoma of the floor of mouth undergoes composite resection and modified radical neck dissection. Final pathology shows extranodal extension (ENE) in one of the cervical lymph nodes. What is the most appropriate adjuvant treatment recommendation?

• A Adjuvant radiotherapy alone
• B Observation with regular follow-up
• C Adjuvant chemotherapy alone
• D Adjuvant concurrent chemoradiotherapy ✓

Explanation

Extranodal extension (ENE) in cervical lymph nodes is a high-risk feature in head and neck squamous cell carcinoma. According to standard guidelines (based on EORTC 22931 and RTOG 9501 criteria), the presence of ENE (along with positive margins) is an indication for adjuvant concurrent chemoradiotherapy rather than radiotherapy alone. This combination has been shown to improve locoregional control and survival in patients with these high-risk pathological features.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.