Do you consider the undissected ipsilateral level IV neck a high or low risk nodal station after selective neck dissection of levels I-III revealed positive node(s)?

For example, for a cN0 oral tongue cancer with I-III dissected with involved LN, pN1, would you use 54 Gy or 60 Gy for level IV? Or do you always take the entire ipsilateral neck to 60 Gy postop? Would this change if the +LN were only in levels I-II vs also involving level III (adjacent vs. non-adjacent to the involved level)? What other factors might affect your dose choice? What about level V?

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Radiation Oncology · University of Texas MD Anderson Cancer Center

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Our general philosophy for the postoperative neck is 3 dose levels:

60 - tumor bed (+ margin),

57 - operative bed,

54 - undissected neck.

These doses are based on treatment in 30 fractions.

Naturally, though, there is the proverbial art versus science. In post op the tumor bed is virtual, often base...

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Radiation Oncology · David Geffen School of Medicine at UCLA

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Typically in the postoperative setting, my 60 Gy volume consists of the tumor bed and preoperative primary/nodal GTV (which has been excised), deformed to the postoperative (current) anatomy, plus an additional 5-10 mm CTV margin. (The margin size may be customized depending on uncertainties in imag...

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Radiation Oncology · UT Southwestern School of Medicine

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One corollary to this question is whether the "risk-level" of a clinically-negative (undissected) neck level should ever influence the dose. The probability of disease in that level (typically what is referred to as "risk") primarily determines whether it should be treated at all; of course, usually...

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