When would you include the superior mediastinal lymph nodes when treating head & neck cancer and how do you define the target volume?
Only when esophagus or thyroid involved? Or also when subglottis and hypopharynx involved?
How do you define the CTV border? Some commonly stated boundaries:
Superior: Suprasternal notch (AJCC; NCCN)
Inferior: Innominate (NCCN H&N section) but carina (NCCN thyroid section)
Anterior: Sternum (NCCN; AJCC)
Posterior: Trachea/esophagus (NCCN; AJCC)
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When would you include the superior mediastinal lymph nodes when treating head & neck cancer? (select all that apply)
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2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Florida
Answered on
Low level 4 and/or 6 nodes.
Mednet Member
Radiation Oncology · Banner MD Anderson Cancer Center
Answered on
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 extension, but we would consider this for very extensive subglottic extension. We do not do it routinely for hypopharynx primaries. We see esophageal involvement rarely, but access of tumor to esophageal lymphatics would be an indication to include upper mediastinal nodes in the treatment volumes.
As for borders, we use the innominate as the lower border rather than the carina, unless paratracheal nodes are involved. The other borders noted in the question above match our policies.