Oral cavity cancer
ICD-10 C06.9ICD-11 2B6Z

Oral cavity cancer: next-line treatment when surgical resection does not achieve complete tumour-free margins

For patients with oral cavity cancer who have undergone primary surgical resection, a further structured treatment step is indicated when histologically tumour-free margins were not achieved, or when pathological review identifies specific high-risk features that increase the likelihood of local recurrence.

Prior line — escalation trigger

Previous treatment — Primary Surgical Resection

The initial approach consisted of surgical resection of the primary tumour, combined with neck dissection and reconstruction where appropriate. The primary goal was complete resection with histologically tumour-free margins (R0). This protocol is indicated when that goal was not fully achieved, or when postoperative pathology reveals high-risk findings.

This protocol — partial overview

Postoperative radiotherapy is the cornerstone of this protocol, with the dose schedule and fractionation determined by the individual patient's risk profile. For patients in whom specific high-risk histopathological criteria are identified, radiotherapy is combined with a systemic agent. The interval between surgery and the completion of radiotherapy is a critical and precisely defined element of this regimen.

Instant Access to Structured Evidence-Based Regimens

References

  • Postoperative radio- or radiochemotherapy shall be given in cases of advanced T category (T3/T4), scarce or positive resection margins, perineural invasion, vascular invasion, and/or lymph node involvement.
  • Postoperative radiotherapy shall be conventionally fractionated and delivered at 54–60 Gy in 27–30 fractions over 5.5–6 weeks for average risk tumors and 66 Gy in 33 fractions over 6.5 weeks for tumors at increased risk of recurrence.
  • Postoperative radiotherapy should be started as early as possible and completed within a maximum period of 11 weeks after surgery.
  • If radiotherapy is indicated, patients with increased histopathological risk criteria for tumor recurrence (resection margin <5 mm and/or extracapsular tumor growth) should receive adjuvant treatment in the form of radiochemotherapy with cisplatin after tumor resection.
View source ↗