When, if ever, would you cover the clinically uninvolved contralateral oropharynx when treating a well-lateralized oropharyngeal cancer of the head and neck?

Topics: Head and Neck Cancers • Radiation Oncology

Are there factors that would make you worry about occult separate primary?

For example, in a small, well-lateralized tonsilar cancer presenting with a contralateral cervical node?

If covering, would you take it to low, intermediate, or high dose?

Answer from: Radiation Oncologist at Academic Institution

The main concern regarding another occult primary in the contralateral OPC is whether or not the ca is smoking/alcohol-related, in which case field cancerization is common and there is a risk of secondary HNC. This risk is much less in HPV+ with little smoking. A SEER study from 1975-2006 foun...

Answer from: Radiation Oncologist at Community Practice

The only time I include contralateral oropharynx is when I am concerned about a synchronous primary either based on clinical suspicion or radiologic appearance (when pathologic confirmation is either missing altogether or is equivocal). Surprisingly, these situations arise fairly often when either s...

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Radiation Oncologist at Bon Secours Mercy Health
In HPV+ non-smoker, the risk of secondary primarie...

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