Safe Omission of Postoperative Neck Irradiation in Selected pN0 Patients With Locally Advanced Oral Cavity Squamous Cell Carcinoma.

BACKGROUND

Postoperative radiotherapy is the standard treatment for locally advanced oral squamous cell carcinoma (OSCC); however, the indication for neck irradiation (NI) in pN0 patients remains debatable. We evaluated whether the omission of NI compromises outcomes in pT3-T4 pN0 patients treated with adequate neck dissection (ND).

METHODS

This retrospective single-institution study included patients with pT3-T4pN0 OSCC who underwent primary surgery, exhaustive ND (≥ 18 lymph nodes), and postoperative radiotherapy limited to the tumor bed. Overall survival (OS), disease-free survival (DFS), and regional control were also analyzed.

RESULTS

Seventy-seven patients were included in the study. After a median follow-up of 51 months, only three nodal recurrences occurred, all associated with local tumor relapse. No isolated neck failures were observed. The regional control rate was 96% and the 5-year OS and DFS rates were 77.6% and 79.2%, respectively.

CONCLUSION

In selected pT3-T4 pN0 OSCC patients undergoing high-quality ND, omission of postoperative NI does not compromise oncologic outcomes. This strategy allows for a meaningful reduction in irradiation volumes and potentially treatment-related morbidity, supporting de-escalation of treatment.