How do you balance target coverage with tolerances of the ipsilateral eye structures and the risk of vision loss in advanced head and neck cancers?  

i.e. T4 sinus tumor with advanced orbital invasion? Would your opinion and approach change in the event the patient responds favorably to neoadjuvant chemotherapy?

Aside from seeing an ophthalmologist early (e.g. at the start of therapy), using appropriate IMRT, and treating with the eyes open, are there specific approaches you would take to minimizing keratitis?

One can live without sight in one eye, but what limits would you impose on that approach?



Answer from: Radiation Oncologist at Community Practice

Answer from: Radiation Oncologist at Academic Institution
Comments
Radiation Oncologist at University of Washington
Agree with above—assuming curative treatment...
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