4
Treatment
Recommendation 2.3b
➤ Concurrent weekly cisplatin may be administered with postoperative
RT to patients who are considered inappropriate for standard high-
dose intermittent cisplatin after a careful discussion of patient
preferences and the limited evidence supporting this treatment
schedule. (Moderate Recommendation; EB-I-B)
Recommendation 3.1
➤ Elective neck dissection is the preferred approach for patients with
oral cavity cancer who require management of the clinically negative
neck as outlined in recommendation 1.1a. Elective radiotherapy to a
non-dissected neck (50-56 Gy in 25-30 fractions) may be efficacious
and should be administered if surgery is not feasible.
(Moderate Recommendation; EB-I-B)
Recommendation 3.2
➤ For patients who have undergone ipsilateral neck dissection only and
are at substantial risk of contralateral nodal involvement (e.g. tumor
of the oral tongue and/or floor of mouth that is T3/4 or approaches
midline), contralateral neck radiotherapy should be administered to
treat potential microscopic disease.
(Moderate Recommendation; EB-I-B)
Oropharynx
Recommendation 4.1
➤ Patients with lateralized oropharyngeal carcinoma who are being
treated with upfront curative surgery should undergo an ipsilateral
neck dissection of levels II-IV. An adequate dissection should include
at least 18 lymph nodes. (Moderate Recommendation; EB-I-B)
Recommendation 4.2
➤ Patients with lateralized oropharyngeal cancer who have neck
dissection concurrently or before transoral endoscopic head and neck
surgery should have ligation of at-risk feeding blood vessels to reduce
the severity and incidence of post-operative bleeding.
(Moderate Recommendation; EB-L-B)
