6
Treatment
Figure 1. Treatment Algorithm for Management of the Neck in
Patients with Oral Cavity Squamous Cell Carcinoma
of the Head and Neck
intravenous bolus cisplatin
(100 mg/m
2
every 3 weeks) should be
offered to patients with extranodal
extension in any positive node,
regardless of the extent of the
extranodal extension and number
or size of involved nodes, and no
contraindications to high-dose cisplatin
Concurrent weekly cisplatin may be
administered with postoperative
radiotherapy 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
For selected highly reliable patients
with cT1, cNO, close surveillance may
be offered by a surgeon in conjunction
with specialized neck ultrasound
surveillance techniques
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
This should include nodal levels, la,
Ib, 1, and lll. An adequate dissection
should include at least 18 lymph nodes
Ipsilateral
Neck
Contralateral
Neck
• Patients classified as cT1
• Patients classified as
cT2-cT4 and treated with
curative-intent surgery
An elective contralateral
neck dissection may be
offered in patients with a
tumor of the oral tongue
and/or floor of mouth that is
T3/4 or approaches midline
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
cNO
Patients with oral cavity
Adjuvant
Chemoradiotherapy
Ipsilateral END
should be
performed
