What are your indications for including the contralateral neck when planning postoperative primary and ipsilateral elective neck radiotherapy for a well lateralized buccal squamous cell carcinoma?

Topics: Head and Neck Cancers • Radiation Oncology

The 2019 ASCO guideline suggests contralateral neck radiotherapy for T3-T4 oral tongue and/or floor of mouth primary sites or tumors approaching midline (Koyfman, J Clin Oncol 2019). A buccal-specific retrospective series reported only 2% contralateral neck failure, including subgroup analysis of N2 and ECE (Lin, Int J Radiat Oncol 2008). For a T1 tumor not close to midline, would a combination of other risk factors (e.g., 5 positive ipsilateral nodes, ECE, largest node size over 4 cm, recurrence in the ipsilateral neck within 3 months of initial buccal surgery) push one to including the contralateral neck?

Answer from: Radiation Oncologist at Academic Institution

No indication for contralateral neck RT in cases of buccal primary ca. If there are high risk features in the ipsilateral neck or primary tumor, LRR risk will mostly be confined to those sites.

Comments

Radiation Oncologist at Bon Secours Mercy Health
I generally agree. I would argue that large ipsila...

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