Mednet Logo

What factors do you consider in deciding when to initiate RT in a pt with an unknown H&N primary (N2c) who has mandibular bone exposure after undergoing teeth extractions?

Understanding that it may be several weeks (or more) before adequate mucosal healing over the mandible, should RT be started regardless? Should he go for bilat neck dissections and hope the mucosa is healed by the time he is ready for post-op RT? Give the loading dose of cetuximab but hold off on the concurrent RT/cetuximab for up to 6 weeks to allow for more healing (my med onc tells me IgG has a half-life of ~6 weeks)? Does your management change if it is p16+? Would it be appropriate to modestly decrease the total dose in order to minimize late mandibular complications?