TABLE 3B.
Clinical condition: Resected p16‐positive SCC of the oropharynx with extranodal extension (ENE).
| Variant 6: | A lifetime non‐smoker with a pT1 N1 M0 p16‐positive SCC of the tonsil treated with transoral radical resection and ipsilateral neck dissection (levels II‐IV). The tumor was 1.5 cm, tonsil‐confined, with a 0.5 cm closest margin. The ipsilateral neck dissection showed 1 out of 22 left neck nodes with a 4.0 cm SCC deposit at level II with 0.2 cm ENE. |
| Question 1: In the presence of ENE, what postoperative therapy is recommended? | |||||
|---|---|---|---|---|---|
| Treatment | Rating category | Group median rating | Disagreement | SOE | SOR |
| Observation (No additional therapy) | U | 1 | EC | ↑ | |
| PORT alone, de‐escalation 50 to 54 Gy | U | 2 | M | ↑ | |
| PORT alone, 60 to 66 Gy | M* | 5 | X | M | — |
| PORT conventional fractionation a + systemic therapy | A | 8 | M | ↓ | |
| Question 2: What radiation volume is appropriate? | |||||
|---|---|---|---|---|---|
| Treatment radiation volume | Rating category | Group median rating | Disagreement | SOE | SOR |
| PORT to primary site + ipsilateral neck | A | 7 | EC | ↑ | |
| PORT to primary site + bilateral neck | A | 7 | EC | ↓ | |
| PORT to ipsilateral neck only | M* | 5 | X | EO | — |
| Question 3: What concurrent systemic therapy is appropriate, if recommended? | |||||
|---|---|---|---|---|---|
| Treatment radiation volume | Rating category | Group median rating | Disagreement | SOE | SOR |
| No systemic therapy | M* | 5 | X | M | ↓ |
| Cisplatin 100 mg/m2 for 2 to 3 cycles | A | 8 | M | ↑ | |
| Cisplatin 40 mg/m2 weekly | M* | 5 | X | L | ↑ |
| Carboplatin AUC2 weekly | M* | 5 | X | L | ↑ |
| Carboplatin AUC2 + paclitaxel weekly | M* | 5 | X | EC | — |
| Cetuximab weekly | M* | 5 | X | EC | — |
| Cetuximab + docetaxel 15 mg/m2 weekly | M* | 5 | X | EO | ↑ |
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.
a
Conventional fractionation refers to 1.8 to 2.0 Gy.