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?

My personal approach is to always recommend induction systemic therapy for T4b unresectable disease with orbital invasion. If it is at all resectable (T4a), I agree with offering curative surgery (including enucleation) upfront or induction if that is a surgeon preference, then post-op chemoRT or RT...

In locally advanced head neck tumors, I generally counsel a higher than normal risk of vision loss in one eye and slightly higher blindness risk. I don't think optic nerve tolerance is solely based on maximum dose and so I routinely take the an optic nerve to 70 Gy.

Preserving the eye itself is of g...