Indications for Postoperative Radiotherapy in Head and Neck Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The definitive indications for postoperative radiotherapy are:
  1. Positive margins
  2. Multiple positive nodes with metastatic disease
  3. Extra capsular nodal extension
  • Less certain indications include:
  1. Lymphovascular space invasion
  2. Perineural spread
  3. Single encapsulated positive lymph node greater than 3 cm
  4. Thick tumors
  • Tumors with a thickness between 3 mm to 9 mm have 44% subclinical node positivity and a 7% local recurrence rate
  • Tumors with a thickness greater than 9 mm thickness have 53% subclinical node positivity and a 24% local recurrence rate
  • Postoperative radiotherapy (60 to 70 Gy in 6 to 7 weeks) reduces the rate of local and regional recurrence from 50% to 15% for tumors with pathologic features that predict a high local and regional failure rates
  • The indications for postoperative radiotherapy are well established:
  1. Close or positive margins
  2. An affected lymph node greater than 3 cm
  3. Multiple lymph nodes involved
  4. Extra capsular extension (ECE)
  5. Patients who had an open biopsy of a suspicious neck node and did not undergo neck dissection at the time
  6. Perineural invasion
  7. Lymphovascular space invasion
  8. Invasion of cartilage, bone or deep soft tissues
  9. Recommendation of the surgeon due to intraoperative findings
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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