When would you include the superior mediastinal lymph nodes when treating head & neck cancer and how do you define the target volume?

Low level 4 and/or 6 nodes.

At our institution, we extend treatment volumes to the upper mediastinum in the following circumstances:

• Level 4B node involvement (of any size)
• Bulky nodal involvement of levels 4A or 4B
• Level 6 nodal involvement
• Thyroid primary

We do not treat the upper mediastinum routinely for subglottic exten...