Topics:
Head and Neck Cancers • Radiation Oncology
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)
Answer from: Radiation Oncologist at Academic Institution
Low level 4 and/or 6 nodes.
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Answer from: Radiation Oncologist at Community Practice
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 subglotti...