A fit 58-year-old undergoes clear-margin resection of a pT3 oral-tongue squamous cell carcinoma with neck dissection. One metastatic cervical node shows extranodal extension. What is the most appropriate adjuvant recommendation?
Extranodal extension is a major adverse pathological feature for which concurrent chemoradiotherapy offers improved locoregional control compared with radiotherapy alone in suitable patients.
A. Observation because the primary margin is clear: Clear margins do not neutralise the high recurrence risk conferred by extranodal extension.
B. Radiotherapy to the primary bed only: The nodal basin and relevant at-risk volumes must be addressed.
C. Postoperative radiotherapy with concurrent systemic therapy if medically suitable: Extranodal extension is a major adverse pathological feature for which concurrent chemoradiotherapy offers improved locoregional control compared with radiotherapy alone in suitable patients.
D. Further tongue resection: The primary margin is already clear and does not treat extranodal disease.
E. Immunotherapy alone as routine adjuvant standard: It is not a routine substitute for indicated postoperative chemoradiotherapy in this setting.
If there were a single pN1 node without extranodal extension and no other adverse features, omission of adjuvant treatment could be considered after multidisciplinary review.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank