How do you treat locally advanced medullary thyroid cancer with postoperative RT?  

What dose and fractionation is appropriate for medullary thyroid carcinoma with extrathyroid extension, bilateral cervical lymph node levels 2-5 with extranodal extension, paratracheal node involvement with extranodal extension, and thymus involvement s/p excision with positive margins throughout?  Gross unresected disease remains in the mediastinum levels 4, 7, and bilateral hilar lymph nodes. Also what is the appropriate literature for treatment guidance?



Answer from: Radiation Oncologist at Academic Institution