American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for squamous cell carcinoma of the neck if there are positive resection margins?

1. Observation without treatment

2. Adjuvant chemotherapy only

3. Adjuvant combined-modality chemoradiation therapy

4. Surgical resection only

The correct answer is: Adjuvant combined-modality chemoradiation therapy

For squamous cell carcinoma of the neck with positive resection margins, adjuvant combined-modality chemoradiation therapy is recommended. This approach is particularly effective in managing residual disease that may not be completely eradicated by surgical resection alone. Positive margins indicate that cancerous cells remain at the surgical site following resection, which raises the risk of recurrence. Adjuvant therapy aims to eliminate any remaining cancer cells that may lead to metastasis or local recurrence. Chemotherapy enhances the effects of radiation therapy, making it a synergistic approach. By utilizing both modalities, the likelihood of controlling the disease is significantly improved compared to using radiation or chemotherapy alone. Other options, such as observation without treatment, adjuvant chemotherapy only, or surgical resection alone, may not adequately address the concern of residual cancer. Observation would leave the patient at increased risk of recurrence, while adjuvant chemotherapy alone lacks the immediate local treatment provided by radiation. Similarly, surgical resection alone might still leave patients with positive margins unaddressed, leading to potential treatment failure. Combining both radiation and chemotherapy therefore provides a comprehensive strategy to manage this advanced scenario effectively.