When, if ever, do you recommend concurrent chemotherapy with definitive RT for early stage oral cavity squamous cell carcinoma?

Early stage oral cavity cancers are best treated with surgery or definitive RT including brachytherapy. If brachytherapy is not feasible and surgery is not an option, I would consider adding cisplatin but it would not be my first choice.

Surgery is the preferred treatment modality for early stage oral cavity cancers. For patients managed non-surgically, definitive RT with brachytherapy +/- external beam radiation therapy has a long track record in the management of early stage oral cavity cancers. Both ABS and GEC-ESTRO brachytherapy guidelines caution against the routine use of concurrent chemotherapy during brachytherapy for the definitive management of H & N cancers. (Nag et al., PMID 11483328, Mazeron et al., PMID 19329209)

Given that H & N brachytherapy is a highly specialized technique not offered at many institutions, patients ineligible for or refusing surgery may only have access to definitive external beam radiotherapy. Concomitant chemotherapy is typically given ...