Adjuvant combined-modality treatment with chemotherapy and radiation is most appropriate for this patient with locally advanced squamous cell carcinoma. Most patients with resected squamous cell carcinoma of the head and neck will require some form of adjuvant therapy. Combined-modality chemotherapy and radiation has been shown to improve survival in patients with either positive surgical margins or lymph node metastases associated with extracapsular extension. Although several earlier studies showed a survival benefit when combined-modality therapy was used for patients with multiple positive lymph nodes without extracapsular extension, more recent studies have failed to confirm a survival benefit in that setting. Therefore, currently, either the presence of positive surgical margins at the primary resection site or of extracapsular lymph node extension is the only standard indication for combined-modality adjuvant therapy. The patient described here clearly meets these criteria.

Although cetuximab alone can be used for patients with advanced disease, it has not been associated with improved survival in the adjuvant setting.

Neither adjuvant chemotherapy alone nor adjuvant radiation therapy followed by chemotherapy has a role in the care of patients with resected squamous cell carcinoma of the head and neck.

Although not listed as an option, adjuvant radiation therapy alone is most often used for patients with earlier-stage disease and is associated with significantly decreased recurrence rates. However, it is not appropriate for patients with either positive resection margins or those with metastatic lymph nodes associated with extracapsular extension. In both of those circumstances, recurrence rates following treatment with radiation alone are clearly higher than those associated with combined chemotherapy and radiation treatment.