Postoperative management of high-risk resectable head and neck cancer

Abstract

Primary surgery is often a treatment modality used in the management of head and neck cancer. For patients with high-risk disease, surgery alone is insufficient, thus mandating a risk-adapted approach to determine which patients benefit most from the addition of adjuvant therapies. Typically, patients with advanced T stage, surgical margin involvement, perineural invasion, lymph node involvement, extracapsular spread, or bone involvement warrant the addition of postoperative radiotherapy. Randomized trials have also identified a select group of patients for whom the addition of chemotherapy concurrent with postoperative radiotherapy has been shown to improve outcomes. Specifically, patients with resected disease whose final pathology demonstrates the presence of extracapsular spread or surgical margin involvement should be treated with adjuvant, platinum-based chemoradiation. Targeted therapies in the adjuvant setting have achieved mixed success and remain under active investigation. The identification of more efficacious and less toxic adjuvant therapies is paramount to maximizing oncologic outcome and quality of life.