A 61-year-old male underwent composite resection of a T3N2b oral cavity carcinoma with level I to III selective neck dissection. Histopathology shows clear margins but extranodal extension in one of four positive nodes. Which adjuvant therapy offers the greatest survival benefit in this setting?

• A Observation with serial PET-CT surveillance
• B Concurrent postoperative cisplatin-based chemoradiotherapy ✓
• C Postoperative radiotherapy alone to 60 Gy
• D Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil followed by observation

Explanation

Extranodal extension and involved surgical margins are the two established high-risk pathological features for which postoperative concurrent cisplatin with radiotherapy improves survival compared with radiotherapy alone. Induction chemotherapy has no role in the adjuvant setting, and observation after N2b disease with extranodal extension would invite early regional failure. Clear margins alone do not offset the nodal risk here.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.