A 48-year-old man undergoes wide local excision of a 3 cm squamous cell carcinoma of the oral tongue with selective neck dissection (levels I-III). Final pathology shows close margin (1 mm) and a single 2.5 cm lymph node with extranodal extension. What adjuvant treatment is indicated?

• A Observation only
• B Adjuvant radiotherapy alone
• C Adjuvant chemotherapy alone
• D Adjuvant concurrent chemoradiotherapy with cisplatin ✓

Explanation

The EORTC 22931 and RTOG 9501 trials established that patients with extranodal extension (ENE) and/or positive margins benefit from adjuvant concurrent chemoradiotherapy with cisplatin (100 mg/m2 every 3 weeks) over radiotherapy alone. ENE is a major adverse feature that significantly increases recurrence risk. The combination improves locoregional control and disease-free survival in high-risk patients. Radiotherapy alone is insufficient for ENE-positive disease. Observation would be inappropriate given 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.