This protocol targets a defined high-risk sub-population: lip cancer at stage III or IV that is operable, but where pathological analysis reveals positive surgical margins and/or extracapsular spread of nodal metastasis. The patient is fit for chemotherapy and aged under 71 years.
Following surgery for stage III or IV lip cancer, the presence of positive resection margins or extracapsular spread of nodal disease identifies patients at elevated risk of locoregional failure. In patients who are fit for chemotherapy and under 71 years of age, this combination of high-risk features guides the selection of adjuvant treatment strategy.
Management in this setting may involve radiotherapy delivered according to specific fractionation schedules, or systemic chemotherapy — with the approach informed by the individual clinical picture. The complete regimen, including drug selection, sequencing, and all clinical parameters, is defined in the full protocol.
DOI: 10.1017/S0022215116000499
In fit patients under the age of 71, adjuvant radiochemotherapy up to 66 Gy with concurrent platinum-based chemotherapy should be considered for those with positive surgical margins and/or ECS.
Palliative RT may be used, either over short fractionation schedules or split course, for patients with advanced and inoperable disease, or those who are not fit for a more toxic, radical approach.
Palliative chemotherapy with platinum-based drugs and 5FU or capecitabine can also be considered to help symptoms and improve survival.
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