Topics:
Head and Neck Cancers • Radiation Oncology
Do you consider the undissected ipsilateral level IV neck a high or low risk nodal station after selective neck dissection of levels I-III revealed positive node(s)?
For example, for a cN0 oral tongue cancer with I-III dissected with involved LN, pN1, would you use 54Gy or 60Gy for level IV? Or do you always take the entire ipsilateral neck to 60Gy postop?
Would this change if the +LN were only in levels I-II vs also involving level III (adjacent vs. non-adjacent to the involved level)?
What other factors might affect your dose choice?
What about level V?
Answer from: Radiation Oncologist at Academic Institution
Typically in the postoperative setting, my 60 Gy volume consists of the tumor bed and preoperative primary/nodal GTV (which has been excised), deformed to the postoperative (current) anatomy, plus an additional 5-10 mm CTV margin. (The margin size may be customized depending on uncertainties in imag...
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Radiation Oncologist at University of Florida
54.
54.
Answer from: Radiation Oncologist at Academic Institution
One corollary to this question is whether the "risk-level" of a clinically-negative (undissected) neck level should ever influence the dose. The probability of disease in that level (typically what is referred to as "risk") primarily determines whether it should be treated at all; of course, usually...
They don't call it the Garden Book for nothing. Th...