A 58-year-old man undergoes composite resection for a pT4aN2bM0 squamous cell carcinoma of the floor of mouth. Histopathology shows clear mucosal margins but one level IB node contains tumour with definite extranodal extension. What is the most appropriate adjuvant treatment?

• A Six cycles of induction chemotherapy alone
• B Radiotherapy alone to the operative bed and ipsilateral neck
• C Concurrent cisplatin-based chemoradiotherapy ✓
• D Observation with surveillance imaging every three months

Explanation

Extranodal extension in any node is one of the two major adverse factors that mandate concurrent platinum-based chemoradiotherapy rather than radiotherapy alone; the other is positive microscopic margins. Clear margins here remove the second indication, but extranodal extension alone is sufficient. Chemotherapy without radiation and observation leave an unacceptable risk of regional failure. Close margins under 5 mm represent intermediate risk managed with radiotherapy alone.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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