{"entity":{"id":"paper-bernier-eortc-22931-nejm-2004","kind":"paper","name":"EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer","aka":[],"tldr":"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.\n\nFive-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.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2004","url":"https://doi.org/10.1056/NEJMoa032641"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/15128894/"}],"tags":[],"related":[],"cancers":["hpv-negative-head-and-neck-cancer","oral-tongue-cancer","oral-cavity-cancer","buccal-mucosa-cancer","lip-cancer","mucoepidermoid-carcinoma","salivary-duct-carcinoma"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2004,"doi":"10.1056/NEJMoa032641","pmid":"15128894","authors":"Bernier J, Domenge C, Ozsahin M, et al.","paperType":"rct","findings":["Five-year overall survival 53 percent vs 40 percent.","Five-year locoregional relapse 18 percent vs 31 percent."],"whatItMeans":"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."],"changedPractice":true,"participants":334},"route":"/key-papers/paper-bernier-eortc-22931-nejm-2004/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"hpv-negative-head-and-neck-cancer","kind":"cancer","name":"HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer)","route":"/cancers/hpv-negative-head-and-neck-cancer/"},{"id":"lip-cancer","kind":"cancer","name":"Lip cancer","route":"/cancers/lip-cancer/"},{"id":"mucoepidermoid-carcinoma","kind":"cancer","name":"Mucoepidermoid carcinoma","route":"/cancers/mucoepidermoid-carcinoma/"},{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"},{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","route":"/cancers/oral-tongue-cancer/"},{"id":"salivary-duct-carcinoma","kind":"cancer","name":"Salivary duct carcinoma","route":"/cancers/salivary-duct-carcinoma/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}