Indications for Adjuvant Therapy

One of the goals of END is to identify those patients who are at increased risk of regional recurrences and distant metastases, and who will potentially benefit from adjuvant therapy. Targeting high-risk patients will minimize the overall cost and morbidity of combined therapies. With this in mind, one must ask what pathologic findings are associated with an increased risk of recurrent disease.

In certain scenarios, the need for adjuvant therapy seems clear. Patients with ECS or with three or more occult nodes receive the recommendation for adjuvant therapy, regardless of whether a selective or comprehensive neck dissection has been performed. The situation is less clear if there are one or two lymph nodes without ECS. Whether a SND constitutes adequate therapy for very limited cervical disease remains unknown. Although the risk of additional occult metastases in the undis-sected zones after SND is very small, can irradiation therapy be withheld if all five zones have not been sampled? Many surgeons would be more confident recommending surgery alone as adequate therapy if a comprehensive procedure had been performed. In a small subset of patients with limited cervical disease, it is possible that comprehensive procedures performed electively may spare them combination therapy and the attendant sequelae.

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