How do you manage the elective lymphatics in high risk squamous cell carcinoma of the skin?
In a clinical N0 patient with high risk (large, deeply invasive, poorly differentiated, +PNI, etc) cutaneous SCC of the head and neck, who do you treat? And when you do offer treatment, what dose/fractionation do you use and how extensive a field do you treat?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · UTMB
Answered on
For the high risk features mentioned in the question, elective RT to draining nodes and neural pathways should be considered. The acceptable dose/fx for elective RT in SCC is generally 50 Gy in 25 fx (ranges from 45-54 Gy). <1.8-2 Gy/fx is acceptable in dose painted plans. For the nodal fields a goo...
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Mednet MemberInvited Expert
Radiation Oncology · Beaumont Health System
Answered on
I agree with above. 50 Gy in 25 fractions is the common fractionation scheme. See UF data. https://www.ncbi.nlm.nih.gov/pubmed/26391010
"Essentially for tumor diameter > 2 cm, tumor thickness > 5 mm, poor differentiation, tumor location within ear, age > 70 years, perineural invasion (PN...
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