When, if ever, would you cover the clinically uninvolved contralateral oropharynx when treating a well-lateralized oropharyngeal cancer of the head and neck?
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?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Michigan
Answered on
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 found that...
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Mednet MemberInvited Expert
Radiation Oncology · HCA South Atlantic
Answered on
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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