In the setting of head and neck cancer, if the pathology report shows extranodal extension (ECE), but the location of the node is uncertain, how do you define your boost volume?

It is important to discuss the case with the surgeon and your pathologist to get their input regarding the size and possible location of the node with ECE within the specimen. Ideally, every surgeon that's performing a neck dissection for possible cancer will orient the specimen and divide it into the classic anatomic levels I, IIa/b, III, etc, and communicate this information clearly to the pathologist. Unfortunately, this may not always be the case in centers that have lower volume experience ...