Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria

Abstract

Background: The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios. Methods: An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodologybased systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier)

Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma

“…4 Certain adverse pathologic features after surgical resection may warrant adjuvant treatment, and they include large tumor size, nodal disease, perineural invasion, lymphovascular invasion, and close margins (<5 mm). 26 , 27 , 28 Given limited data on adverse pathologic risk features for recurrent HNSCC after salvage surgery, the criteria for adverse pathologic risk features in an index cancer was also used for recurrent cancer or SPC to identify patients in our institution who would benefit from adjuvant re-RT. Because of an absence of any standardized guideline for adjuvant re-RT in this population, our institution's preferred adjuvant re-RT treatment is 60 to 66 Gy with the exact dose dependent on the prior RT treatment, the particular adverse histopathologic features, the patient's overall clinical status, and the physician's preference.…”

Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis

“…Different reporting modalities for margin status among clinical trials represent a specific concern that could affect a clear understand of disease outcomes when comparing published studies. This consideration could produce subsequent controversies regarding the appropriate indication for postoperative approaches according to margin status [ 130 ]—in particular, limited consensus still exists on the appropriate RT fractionation regimen and radiation volumes [ 130 ].…”

Squamous Cell Carcinoma of Head and Neck

“…An OS benefit of an alternative schedule of cisplatin administration of weekly 50 mg/m 2 added to PORT was also demonstrated for stage III/IV SCCHN with ENE; however, the LRC was not proven [83]. The Japanese group (JCOG 1008) trial also showed the non-inferiority of the alternative schedule weekly cisplatin 40 mg/m 2 to three-weekly cisplatin in high-risk patients with microscopically positive margin and/or ENE [84]. In general, PORT should be commenced within 6 weeks after surgery [85].…”