# EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer

Source: https://onco.cc/key-papers/paper-bernier-eortc-22931-nejm-2004/  
OnCo record `paper-bernier-eortc-22931-nejm-2004` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding cisplatin to radiotherapy after surgery for high-risk head and neck cancer improved local control and survival, and with the parallel American trial defined extranodal extension and positive margins as the indications for postoperative chemoradiation.

## Summary

Phase 3 trial of 334 patients with resected stage III to IV head and neck squamous cell carcinoma with high-risk features randomised to postoperative radiotherapy alone or with three cycles of concurrent cisplatin.

Five-year progression-free survival was 47 versus 36 percent and overall survival 53 versus 40 percent with chemoradiation, with more severe acute mucositis; a combined analysis with RTOG 9501 showed the benefit was confined to patients with extranodal extension or positive margins.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2004
- DOI: 10.1056/NEJMoa032641
- Authors: Bernier J, Domenge C, Ozsahin M, et al.
- Findings: Five-year overall survival 53 percent vs 40 percent.; Five-year locoregional relapse 18 percent vs 31 percent.
- What it means: Cisplatin chemoradiation after surgery is standard for extranodal extension or involved margins; radiotherapy alone suffices for other adverse features.
- Caveats: Cisplatin at 100 mg per square metre every three weeks is poorly tolerated; weekly dosing is common in practice.; Trial predates HPV stratification.

## Sources

- N Engl J Med 2004: https://doi.org/10.1056/NEJMoa032641
- PubMed: https://pubmed.ncbi.nlm.nih.gov/15128894/

## Connected records

- cancers: [Buccal mucosa and gingivobuccal cancer (oral cancer in India)](https://onco.cc/cancers/buccal-mucosa-cancer/), [HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer)](https://onco.cc/cancers/hpv-negative-head-and-neck-cancer/), [Lip cancer](https://onco.cc/cancers/lip-cancer/), [Mucoepidermoid carcinoma](https://onco.cc/cancers/mucoepidermoid-carcinoma/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Oral tongue and floor of mouth cancer](https://onco.cc/cancers/oral-tongue-cancer/), [Salivary duct carcinoma](https://onco.cc/cancers/salivary-duct-carcinoma/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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