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Head and Neck Cancers • Radiation Oncology
How do you manage pT1-2N0 p16+ tonsil cancer treated with TORS and ipsilateral negative neck dissection but with positive margin?
As we see more TORS being done, we sometimes run into the above scenario which could have been cured with RT alone.
Do you add concurrent chemotherapy based on +margin?
Do you add elective (ipsilateral) neck RT despite completed negative dissection?
Answer from: Radiation Oncologist at Community Practice
This would be a very unusual situation, especially if the Q is in reference to the palatine tonsil. A well trained Robotic surgeon generally would not have any problems with performing a Radical tonsillectomy for an early stage tonsil primary. The superior constrictor and the pillars (ant+post) ...
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Answer from: Radiation Oncologist at Academic Institution
I completely agree with @Upendra Parvathaneni's comments. In the hands of a well-trained head and neck surgeon, the chance of a positive margin in a T1-2 tonsil/ base of tongue ca would be very unusual. Even if this were to happen, a re-excision should be attempted. If these T1-2 opx cancers are com...
Answer from: Radiation Oncologist at Community Practice
We see this on occasion from surgeons in the community and I do not consider it a true oncologic surgery, and would also treat with radiation therapy alone if re-excision from a well trained surgeon is not possible. I just consider it a big biopsy and do not see a role for concurrent radiation. I wo...