1358 / 2351
5/30/16
13
Low risk (LR): no adverse feature
Intermediate risk (IR): risk factors other than R1 or ECE/STE
High risk (HR): R1 or ECE/STE
•Extracapsular extension / soft tissue extension (ECE/STE)
•Oral cavity tumors
•R1 surgical margins
•Nerve invasion
•>1 neck nodes
•>1 positive node levels
•Node size > 3 cm
•> 6 week interval between surgery and RxTh
Post-operative Radiotherapy: risk factors
Peters, IJROBP, 1993
EHNS-ESTRO H&N course
Florence, June 2016
Patients with positive margin and/or ECE
Post-operative Radiotherapy: overall survival
%
S
U
R
V
I
V
I
N
G
0
25
50
75
100
YEARS
0
1
2
3
4
5
%
S
U
R
V
I
V
I
N
G
0
25
50
75
100
YEARS
0
1
2
3
4
5
EORTC 22931
RTOG 9501
P = 0.019
P = 0.063
RT-CH
RT-CH
RT
RT
Overall survival
Bernier, NEJM, 2004
Cooper, NEJM, 2004
EHNS-ESTRO H&N course
Florence, June 2016