EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer
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.
Overview
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.
- Five-year overall survival 53 percent vs 40 percent.
- Five-year locoregional relapse 18 percent vs 31 percent.
Cisplatin chemoradiation after surgery is standard for extranodal extension or involved margins; radiotherapy alone suffices for other adverse features.
- Cisplatin at 100 mg per square metre every three weeks is poorly tolerated; weekly dosing is common in practice.
- Trial predates HPV stratification.
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