TABLE 1B.
Clinical condition: Resected early‐stage SCC of the oral cavity with a close margin.
| Variant 2: | pT2 N0 M0 moderately differentiated SCC of the right lateral oral tongue treated with a partial glossectomy and ipsilateral neck dissection (levels IA‐B, II, III, IV). Pathology showed a 2.5 cm SCC, 0.4 cm depth of invasion, <0.1 cm deep margin, 24 negative lymph nodes, no perineural invasion or lymphovascular invasion. |
| Question 1: What additional therapy is recommended for the close margin? | |||||
|---|---|---|---|---|---|
| Treatment | Rating Category | Group Median Rating | Disagreement | SOE | SOR |
| Observation (No additional therapy) | U | 2 | L | ↑ | |
| Re‐excision and no additional therapy if no residual SCC | M* | 5 | X | L | ↑ |
| PORT alone 60 to 66 Gy | A | 7 | L | ↑ | |
| PORT alone altered fractionation a | M* | 5 | X | L | — |
| PORT conventional fractionation b + systemic therapy | M* | 5 | X | L | — |
| Question 2: If radiation is recommended, what volumes are appropriate? | |||||
|---|---|---|---|---|---|
| Treatment | Rating category | Group median rating | Disagreement | SOE | SOR |
| Radiation volume | |||||
| PORT to primary site only | M* | 5 | X | L | — |
| PORT to primary site + ipsilateral neck | M* | 5 | X | L | — |
| PORT to primary site + bilateral neck c | M* | 5 | X | L | — |
Notes: Rating: A‐Usually appropriate; M‐May be appropriate; U‐Usually not appropriate. Disagreement, that is, the variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation (see narrative text). When there was disagreement, the group median rating was set automatically to 5. Strength of Evidence: S‐Strong; M‐Moderate; L‐Limited; EC‐Expert consensus; EO‐Expert opinion. Strength of Recommendation: ↑ Strong Recommendation; ↓ Weak Recommendation; — Additional considerations do not strengthen or weaken the panel's recommendation.
Abbreviations: PORT, postoperative radiation therapy; SCC, squamous cell carcinoma of the head and neck; RT, Radiation Therapy.
Altered fractionation refers to >2.0 Gy per fraction and/or >5 fractions per week. This excludes the practice of simultaneous integrated boost of >2.0 Gy per fraction to a limited high‐risk area.
Conventional fractionation refers to 1.8 to 2.0 Gy per fraction, given once daily, 5 days per week.
For this specific variant, “bilateral neck” refers to RT of any contralateral nodal region including contralateral level IB. Of note, these guidelines do not provide granularity regarding specific nodal chains of treatment.