Topics:
Head and Neck Cancers • Radiation Oncology
How would you treat a previously irradiated localized recurrence of an adenoid cystic carcinoma of the nasopharynx?
The patient previously underwent resection with close margins, adjuvant radiation to 66 Gy/33 fractions.
Serial MRIs demonstrate progression with concern for perineural spread along the trigeminal nerve.
How would you approach this case? If reirradiating, what dose/fractionation scheme: hypofractionated, accelerated hyperfractionation, something else?
Answer from: Radiation Oncologist at Academic Institution
Assess resectability. If not suitable for gross total resection, and likely not, protons.
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Answer from: Radiation Oncologist at Community Practice
I have used 66 Gy/55 fx at 1.2 Gy/fx given BID to gross disease along with 55 Gy/55 fx to at-risk cranial nerves. Disease was locally recurrent along nerves in a field that had previously gotten 66 Gy/33 fx ~15 years ago. The patient was symptomatic with facial weakness and pain. She was extensively...