The Study: Treatment of cutaneous head and neck squamous cell carcinoma (HNSCC) often has to be extrapolated from mucosal HNSCC because...there's no other data. Therefore the POST trial was a practical one. It evaluated the efficacy of concurrent chemoradiation for high-risk (HR) cutaneous HNSCC. Patients with either HR nodal disease (one parotid node and/or cervical nodes wither with ECE or >3 cm or at least two in number) or a HR primary tumor (T3, T4, or in-transit disease) were randomized post-wide local excision to adjuvant radiation +/- weekly carboplatin. Here’s where things get unfortunate, as in Virginia-UMBC unfortunate. First, the trial was started right as intensity modulated radiation (IMRT) took off. So IMRT wasn’t allowed, pressing the brakes on an already slow accrual. Second, we now know that weekly cisplatin is inferior to q3 weekly cisplatin for mucosal HNSCC. And we’re willing to bet weekly carbo is even inferior-er. As you might expect, the addition of carbo failed to improve any local control or survival outcomes. One reason may have been the lack of enrollees with the mucosal risk factors known to benefit most from chemo: Only about half had ECE and 5-10% positive margins.
Bottom Line: Weekly carboplatin with adjuvant radiation therapy does not improve locoregional control in patients with high-risk cutaneous HNSCC. | Porceddu, J Clin Oncol 2018