What volume would you treat with radiation in the setting of high risk oral tongue cancer completely resected with surgery and negative bilateral neck dissections?

Topics: Head and Neck Cancers • Radiation Oncology

For example pT4 and PNI, do you target the neck after a negative neck dissection?

What factors influence the decision to treat: - surgical bed alone - entire oral tongue and surgical bed to the same “intermediate risk” dose (57-60 Gy) - surgical bed to an “intermediate risk” dose and rest of oral tongue to a “low risk” dose (50-54 Gy)?

Answer from: Radiation Oncologist at Academic Institution

Despite negative margins and pN0, the risk of LRR in this pT4 patient is high, regardless of whether or not the number of dissected nodes was adequate. Moreover, the chance of surgical salvage if recurrence happens in a previously dissected neck is small, as such recurrent tumors tend to encompass t...

Comments

Radiation Oncologist at Bon Secours Mercy Health
I agree with @Avraham Eisbruch completely. Lest we...

Radiation Oncologist at Veterans Administration Hospital, Jackson,MS
I agree with Dr. @Avraham Eisbruch.

Radiation Oncologist at CCare
Would you treat the entire volume to 60Gy? Or lowe...

Answer from: Radiation Oncologist at Academic Institution

Despite negative margins and negative nodes, if there are other clinicopathological indications for PORT (pT3/4 primary, depth of invasion, close surgical margins, PNI, or LVI), then standard radiation volumes would encompass the resected primary site + dissected neck(s) +/- elective regions to dose...

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