Head and Neck Cancers&nbsp;&nbsp;&nbsp;

Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?

If you recommend or use induction chemotherapy, what is your preferred chemotherapy regimen?

What are your top takeaways in Head & Neck Cancers from ASTRO 2024?

What is the recommended approach for systemic therapy for patients with locally recurrent p16-positive SCC of the oral cavity who are not candidates for resection or re-irradiation?

What would be the optimal choice of chemotherapeutic agents and duration?

What are the indications for adjuvant radiation for a resected intracapsular carcinoma ex pleomorphic adenoma of the parotid?

Do you approach similar to pleomorphic adenoma since it is still non-invasive? If there are indications for treating the primary, do you also elective...

Are there any special treatment considerations when treating a patient with laryngeal cancer with significant Reinke's edema of the vocal folds?

How do you treat SNUC?

Do you prefer upfront cisplatin/etoposide for 2 cycles, then 50 Gy with ENI, then resection, or induction chemo followed by definitive chemoradiation?...

How would you best manage C-spine osteoradionecrosis?

How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?

Is there a role for prophylactic Trental and vitamin E in a patient at high risk for osteoradionecrosis?

How should verrucous carcinomas of the head and neck be managed?

Should lymph nodes ever be targeted? If bone invasion or erosion is present, and surgery is not feasible, is radiation appropriate, and to what dose?

When would you consider larynx preservation in patients with T4N+ SCC of the larynx?

What is your experience with Gelclair for oral mucositis during head & neck radiotherapy?

In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?

How should you approach treating curable laryngeal cancer with chemo-RT in a patient who had a myocardial infarction during treatment and requires CABG, given the cardiotoxicity of cisplatin and 5FU/carboplatin?

In a patient with bilateral neck level II small cell carcinoma with no apparent primary after workup with plans to receive concurrent cisplatin/etoposide, what would be your treatment volumes?

What is the recommended adjuvant dose for neuroendocrine cancer in the head and neck?

What dose would you give for ECE in this setting?

What dose and regimen would you treat a stage I laryngeal cancer s/p R1 resection?

In what situations, if any, would you add chemotherapy to adjuvant radiotherapy in patients with resected head and neck cancer without ENE or positive magrin?

Would a combination of other adverse features such as PNI, GIII, close margin, multiple positive nodes, T4 disease and others make you recommend chemo...

How would you approach patients with high risk mucoepidermoid carcinoma (high grade) of the parotid gland for optimal adjuvant treatment?

Would you consider 50 Gy in 20 fractions for a primary head and neck malignancy in an elderly patient with poor KPS?

For a non-metastatic head and neck cancer patient in his early 80s with an ECOG PS of 3 who has already lost about 20 pounds, how would you favor appr...

Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?

Bentzen et al., IJROBP 2023

Would you prescribe TKIs for Stage IV differentiated thyroid cancer patients who are RAI-naive, with preserved performance status, and are not eligible for surgery?

How would you approach cT3N0M0 squamous cell carcinoma of the supraglottic larynx in a patient with a history of breast cancer and prior radiation to the supraclavicular fossa?

Do you recommend radioactive iodine for Hürthle Cell thyroid carcinoma?

Compared with other thyroid carcinomas, Hürthle cell cancer has a lower avidity for 131I; therefore, treatment with radioactive iodide has l...

Would you recommend adjuvant neck radiation for metastatic chordoma to cervical lymph node, s/p neck dissection, with 1/10 positive nodes and no residual on post op imaging?

Do you use any thyroid dose constraints for head neck radiation planning?

Is there a role for radiation in biphenotypic sinonasal sarcoma?

Biphenotypic sinonasal sarcoma is a recently described malignancy showing dual differentiation with both myogenic and neural elements.

In what clinical situations do you order NavDx?

How do the results affect your recommendations for workup and management?

Would you modify your treatment approach for treating an HPV-positive head and neck cancer in a patient with symptomatic Sjogren's?

What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?

For example, do you favor using different induction chemotherapy (gemcitabine/cisplatin or TPF) for endemic vs non-endemic disease? Do you favor usin...

Would you consider palliative RT in the setting of tumor causing osteonecrosis in an elderly patient?

Patient has not received radiation therapy in the past. If not, what would you offer for palliation of pain?

What is your radiation dose/volume for adjuvant treatment of a clear cell odontogenic carcinoma of the mandible after segmental resection?

Any particular considerations for +PNI, close 1mm margin and 0/29 LN?

Would you recommend lymph node biopsy in a patient with SCC of the right ventral tongue (~1 cm) post excision with close margins and no noted adenopathy on imaging?

What is your approach to managing asymptomatic ORN of the mandible?

Is it appropriate to dose de-escalate in low risk HPV+ SCC of the oropharynx outside of a clinical trial setting?

Such as those meeting the eligibility criteria for NRG HN002, <10 pack years, HPV+ T1-2N1-2b, T3N0-N2b

9 Answers available

How do you consider the role of probiotics for mucositis mitigation in patients receiving head and neck radiotherapy?

In light of the 4/2024 JCO publication by Peng et al., PMID 38215354

How would you approach SCC of unknown primary, p16-, EBV-, metastatic to a large 5.5 cm level 2 neck node, if you suspect a cutaneous origin after clinical workup?

Would you recommend neck dissection and adjuvant ipsilateral RT?

How do you manage pT1-2N0 p16+ tonsil cancer treated with TORS and ipsilateral negative neck dissection but with positive margin?

As we see more TORS being done, we sometimes run into the above scenario which could have been cured with RT alone. Do you add concurrent chemotherap...

Would you offer adjuvant immunotherapy after salvage neck dissection for persistent nodal disease after definitive chemoRT for a patient with p16+ oropharyngeal SCC?

Do you typically recommend avoiding neupogen during radiation treatments?

What dose/fractionation would you use for a multiply recurrent and now unresectable ameloblastoma involving the masticator space, pterygopalatine fossa, and right maxillary sinus?

What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?

What techniques and doses would you prescribe to the primary and regional nodes?

In what scenario would you recommend induction chemotherapy prior to chemo-radiation in head and neck cancers and what would be the preferred regimen?

How do you counsel patients and partners of patients with HPV+ cancers regarding the HPV vaccine?

This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo

What are magic mouthwash alternatives that you would recommend?

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

9 Answers available

How do you manage a patient who finished chemoRT for head and neck cancer and loses >10% body weight within 2 weeks post-treatment?

When would you offer post-operative concurrent chemoradiation in anaplastic thyroid cancer?

Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?

How would you treat a stage IIA NS HD patient with bulky disease who refuses chemotherapy?

What field design and dosing is most appropriate? Would you use ISRT or a more extended field?

What dose and fractionation would you use for Kaposi’s sarcoma of the tonsil post op?

I have an interesting case of gentleman in his 40s, HIV+ but viral count undetectable and CD4 1000+. He had prior diagnosis of Kaposi’s sarcoma ...

How would you manage an early stage HPV mediated pure adenocarcinoma of the tonsil with a large but resectable primary and multiple ipsilateral nodes without clear ECE on imaging?

How would you approach an early stage p16+ SCC of the tonsil s/p TORS and neck dissection with initial positive margins but then negative on re-resection?

Would you still treat the primary site and to what dose?

For locally advanced adenocarcinoma of the maxillary sinus, how should the neck be managed?

Would you manage different whether ND was completed or not?

For a small (<5 mm) hard/soft palate junctional primary with DOI <2 mm status post limited excision with negative but close deep margin, how would you approach neck management in the adjuvant RT setting?

Patient declined additional wider excision due to associated function morbidity as well as neck dissection. What would you estimate is the risk of cli...

Do you have experience using photobiomodulation (Low Level Laser Therapy) to prevent and/or treat patients with oral mucositis or other side effects from chemo and radiation?

How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?

What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?

Is T4 disease a contraindication?

Do you use brachytherapy for treating primary tumors of the lip with definitive radiation?

Are the results superior to alternative treatment methods?

How would you approach a laryngeal adenoid cystic carcinoma in a patient seeking larynx preservation?

What dose, fractionation, and volume would you choose? Would you electively cover the vagal nerve(s) and associated recurrent laryngeal nerves? Does...

Would you offer whole lung radiation therapy in a head neck patient who relapsed with multiple lung only mets?

What is your approach to reporting mandible dose received to the dentist/oral surgeon?

Do you have a standard reporting format with specific doses?

What would be your approach to the treatment of limited stage extrapulmonary small cell carcinoma of the nasopharynx with bilateral cervical lymphadenopathy?

Specifically, with respect to sequencing of chemotherapy, dosing and target delineation- would you cover elective areas like standard NPC fields or gr...

How do you approach cisplatin ineligible patients with bulky EBER positive nasopharyngeal SCC for induction chemotherapy?

How would you determine ipsilateral vs bilateral neck irradiation for early stage, well lateralized nasal cavity SCC?

What is your approach to treating inoperable mucosal melanoma of the head and neck region?

What is the preferred dose, fractionation, and role of concurrent chemo?

How would you manage the contralateral neck and adjacent structures for a glossotonsillar or glossopharyngeal sulcus primary cancer if well lateralized?

Does the entire bilateral BOT & ipsilateral tonsil need to be included in the elective CTV?

Is it safe to irradiate a patient with Cowden syndrome?

In an asymptomatic patient, would this be safe?Is there any reason to withhold radiation such as in the case of T1N0 breast cancer advising the patien...

Any role for adjuvant systemic therapy for resected sebaceous skin carcinoma?

Does a negative neck dissection adequately cover the treatment of the neck for a patient that clearly needs PORT for an oral tongue cancer?

In a patient with a pT1-2 oral tongue cancer resected with negative margins and with a fully negative ipsilateral neck dissection, but with indication...

How do you approach patients with SMARCB1 deficient sinonasal carcinoma for immunotherapy?

How do you advise a patient on ozone therapy?

Would you advise against concurrent ozone during head neck radiotherapy for a locally advanced tumor?

If you must start adjuvant radiation more than 6-8 weeks postoperatively, whether due to complications or healing, do you accelerate treatment in any way?

If so, how do you accelerate?

When would you offer definitive or adjuvant RT for solitary fibrous tumor or hemangiopericytoma in the head and neck?

What can be done to help rehabilitate trismus secondary to radiation and surgery?

In oral cavity cancers, how does WPOI (worse pattern of invasion) influence your decision to offer adjuvant therapy?

For a patient with pT2N0 oral tongue cancer and no other adverse risk features (no LVI or PNI), would WPOI 4 or 5 be enough to offer adjuvant radiatio...

What post-treatment imaging do you recommend for glomus jugulare tumors (paragangliomas) following definitive radiation therapy?

Do you recomment MRI, CT with contrast or CT angiogram? And at what time intervals post-treatment do you perform surveillance scans?

How would you manage worsening severe macroglossia affecting function in a patient after definitive chemoradiation in the subacute setting for p16+ SCC of the base of tongue?

In an otherwise healthy patient with no contributory PMH, medications and without any evidence of disease.

Does the extent of ENE affect your recommendation for concurrent chemotherapy in HPV+ OPSCC patients planned for adjuvant RT?

Does the ENE of 1 mm or less versus >1 mm as in ECOG 3311 affect your decision?

What dose are you routinely using for adjuvant RT for intermediate risk p16+ SCC of the OPX s/p TORS?

For patients who fall into the E3311 intermediate risk category s/p TORS, do you routinely treat to 50 Gy? Or do you continue to treat to 60 Gy?

In light of de-escalation data, for patients undergoing standard dose radiation for favorable HPV + oropharynx cancer, do you accept lower coverage of the low-dose RT field to better spare OARS?

How would you treat a patient with p16 (-) neck lymph node metastasis of an unknown primary, considering their history of prior supraclavicular and chest wall irradiation?

What is your approach to counseling patients who require definitive radiation therapy to the head and neck but for whatever reason, cannot/will not undergo recommended extractions?

Do anticipated fields affect whether extractions are required i.e., limited field glottic larynx could forego?

How do you counsel patients regarding timing of dentures after definitive/post-operative H&N radiation with pre-treament tooth extractions?

How do you approach patients with metastatic SCC of the larynx, PD-L1 <1, unable to tolerate 5-FU based chemotherapy due to grade 4 esophagitis/mucositis?

Do you take the primary dissected site for postoperative oral cavity cancers with bony invasion to 66 Gy?

Do you take it to 66 Gy even in the situation of negative margins/resection of that region of bone? For example, if there is a focal bony invasion tha...

How do you manage postoperative head and neck cancer patients who have difficulty completing simulation due to copious secretions?

Aside from suctioning, what are other measures could be helpful?

Do you offer neoadjuvant radiation therapy for oral cavity sarcoma?

If so, what dose/fractionation? Pathology: High grade spindle cell sarcoma

For a patient treated with Mohs surgery for a high risk skin cancer of the head/neck do you post-operatively treat all scars to full dose, including those created at subsequent closure?

I have seen some patients who may undergo large complex closures (sometimes as a separate procedure) for smaller lesions with resulting scars that sig...

For patients with recurrence or second primary in the head and neck after prior radiation, what would be the postoperative indications for adjuvant radiation?

For HPV-negative head and neck cancer of unknown primary after proper work up and biopsies, what mucosal surface(s) do you cover?

What factors influence your decision? How do you manage these cases differently than HPV positive cases?

How do you approach patients with locally advanced nasopharyngeal squamous cell carcinoma post induction chemotherapy with gemcitabine/cisplatin and imaging showing mild progression?

Can cisplatin be used again with chemo-radiation?

When would you offer radiation for poorly differentiated thyroid cancer?

How would you manage a papillary thyroid carcinoma incidentally found on planning CT for T1 glottic cancer?

How do you prioritize treatment? Would you move forward with radiation to the larynx, and if so, any modification to your treatment plan?

How do you balance the need for wound healing and time to treatment initiation in head and neck cancer patients who require a second operation?

Multiple disease sites have studies showing time from surgery to post operation therapy impacts clinical outcomes. Is there any evidence to suggest th...

How do you approach patients with severe mucositis receiving chemo-radiation for head and neck cancer with regards to empiric antifungal or antiviral treatment?

Severe lymphopenia can develop during treatment and increase the risk of Candida/HSV superinfection, along with potential challenges for any procedure...

When starting HN radiation, which start day do you prefer to add most value to the treatment course?

Would you rather postpone treatment start to the following week if unable to accommodate your preferred start day?

What approach do you take to determine dose constraints for SBRT reirradiation of the head and neck?

Do you have formal constraints and evaluate cumulative doses on the composite plan? Do you use traditional constraints but account for repair?

How do you approach patients with recurrent papillary thyroid cancer following thyroidectomy who now has palpable cervical nodes and underwent neck dissection and RAI?

In a patient with very advanced head and neck cancer treated with induction chemotherapy and then definitive radiation do you recommend adding concurrent chemotherapy with the radiation?

After initial induction chemo, how do you choose between radiation alone or concurrent CRT?

What is your approach for treating oligometastatic head and neck cancer to an adjacent nodal site (ie. axilla, mediastinum etc.) with radiation therapy?

Would you offer definitive chemoradiation and include the non-regional nodal level in your plan?

For very large locally advanced head and neck primary malignancies (namely SCCa), how do you decide between adaptive re-planning of a VMAT/IMRT plan during chemo-RT as option instead of induction chemotherapy?

When do you recommend adjuvant radiotherapy for a resected oncocytic carcinoma of the submandibular gland?

Please comment on primary tumor size, extent of nodal involvement, and other adverse features.

How would you simulate and ensure set-up reproducibility for a patient with head and neck cancer and severe claustrophobia and unable to tolerate a thermoplastic mask?

How do you approach patients with node positive sebaceous cell carcinoma of the eyelid for adjuvant chemotherapy and radiation?

How would you approach new dermal mets in a patient who recently finished chemoradiation for head and neck SCC?

How would you manage patients with exposed bone due to injured gingiva after recent chemoradiation?

Any experience using phenytoin?

How, if at all, would adenosquamous histology affect your coverage volume compared to squamous cell carcinoma of the head and neck?

How would your neck coverage change (unilateral vs. bilateral, levels etc.)? Are there situations where you would cover bilateral neck for adenosquamo...

In a patient with history of successfully treated locally advanced H&N cancer, how do you discern between a metachronous second primary locally advanced lung SCC vs. metastatic head and neck SCC?

What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...

What is your approach to treat metastatic poorly differentiated thyroid cancer with papillary features?

Is there any role for RAI?

How would you treat a carcinoma in situ of the larynx with involvement of the false cord and arytenoid mucosal surface?

Would you offer RT if persistent disease despite resections? Would you prophylactically treat any lymph nodes due to risk of possible occult invasion...

When, if at all, do you use nasolacrimal duct stents to prevent stenosis/obstruction when treating skin, sinonasal, or other mid-facial H&N cancers with radiation therapy?

If so, what is your selection criteria? How long do they remain in place? Do you have any dose constraints to the nasolacrimal duct?

When treating sinonasal undifferentiated carcinoma (SNUC) with induction chemotherapy followed by definitive chemoradiation, do you include the entire pre-chemo volume in your high-dose CTV?

What factors would prompt you to offer post-operative RT in early-stage (T1-2N0) nasal cavity squamous cell carcinoma?

Please comment on how you view risk factors such as T-stage, tumor grade, P16 positivity, margin status PNI, LVI etc. What dose/fractionation and vol...

Do you consider prior use of cisplatin for a previously diagnosed cancer a contraindication for its use as radiosensitizer in a new head & neck cancer?

What precautions, if any, should be instituted with the prior cisplatin exposure?

What definitive dose would you use to treat a recurrent basal cell carcinoma in the oral cavity?

Would you hypofractionate at all? Or use standard H&N doses of 70 Gy/35 fractions?

In patients with nasopharyngeal SCC that have an excellent response to induction chemo, do you alter your chemo-RT dose/volumes in any way?

For example, initial imaging shows numerous bilateral nodal mets extending into the low neck but after induction gem/cis, originally involved nodes ar...

What anesthetic spray do you use (if any) for numbing the nasal passages when performing nasolaryngoscopy?

Our patients seem to hate the 20% benzocaine spray (cherry) saying that it burns and causes their eyes to water. Looking for other options.

Would you offer definitive radiation therapy for extracranial schwannoma located in the neck?

Tumor factors: Neck mass, 6 cm in length, biopsy proven schwannoma. No extension into base of skull Patient factors: No dysphagia, no dysphonia i.e. ...

Do you recommend treating pre-chemo volumes to full prescription dose for locally advanced nasopharyngeal cancer following induction chemotherapy?

What is the significance of LVSI in determining post-op management for oropharyngeal cancer?

Would you recommend PORT based on LVSI as the sole risk factor (i.e. pT1/T2N0 OP SCCa)?

With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?

If using cetuximab, would you recommend accelerated fractionation?

Is there a dose to the lens that would be a contraindication for future cataract surgery?

When, if ever, would you consider dose de-escalation for HPV-associated non-oropharyngeal HNSCC?

Do you consider increased tumor thickness alone as an indication for postoperative radiation in oral cavity cancers?

Is there a thickness cutoff you use? What would you cover?

Per the latest ASCO and ESMO guidelines, which stage II NPC patients would you omit concurrent cisplatin?

When using hyperfractionation with a BID regimen, what are typical dose constraints for the head and neck?

What is the appropriate dose to the dissected node-negative neck with indication for radiation due to advanced primary?

Is it 54 Gy or do we worry about hypoxia and need to go to 60 Gy? Does it change based on site (i.e., oral cavity versus a T4N0 larynx)? There appear...

When treating with electrons, what is your approach to skin collimation to reduce penumbra next to structures such as the eye?

What are best practices for oncologists during the national platinum shortage?

Please specify how your institution is allocating resources now or will be soon.

13 Answers available

What is the significance of PNI in oropharyngeal cancer?

Do you take this into consideration when recommending treatment?

In what situations, if any, would you recommend adjuvant concurrent chemoradiation rather than RT alone?

Margin status? Residual disease? Nodal status/ENE?

Is there a high risk CTV volume for epiglottis primary?

If so, what is included in that volume?

Are there any particular considerations to take when external beam radiation is recommended in a patient who has received RAI before?

Will you wait to simulate, or resimulate, a patient after teeth extractions in preparation for HN cancer treatment?

If only a few teeth, do you still wait to simulate until after the dental work?

How are you managing patients with H&N cancers meriting definitive concurrent chemoRT during cisplatin shortages?

Are you waiting until drug availability or changing to a preferred non-cisplatin radiosensitizer? If you're utilizing an alternative to cisplatin, wha...

How do you handle the obturator prosthesis during radiation delivery for SCC of hard palate?

Do you leave it in or out during sim and treatment? Any special instructions?

What is your approach to adjuvant radiotherapy for head and neck cancer after resection and reconstruction with a free tissue (muscle and bone) flap?

How much time is recommended to wait before? Does the dose or fractionation need to be modified given the flap? Does the scar need to have bolus?

Would you omit postoperative radiation to the neck for a patient with advanced T-stage HNSCC and high risk features and bilateral pN0 neck dissection?

For example, a pT4N0 oral cavity cancer with focally positive margins?

How would you treat the primary site of an adenoid cystic carcinoma of the floor of mouth s/p resection with positive margins with oligometastatic disease?

Would you offer full dose adjuvant radiation? Assume excellent performance status and inability to perform further surgery on margins without causing...

In which scenarios, would you consider a planned neck dissection following definitive radiation therapy?

Do you have a preference between using 2 dose levels (5940/6996) versus 3 dose levels (5700/6300/6996) for NPC, EBV+ and why?

Are you treating with the superoxide dismutase mimetic Avasopasem (GC4419) for patients receiving chemoradiation for head & neck cancers?

After the randomized Phase IIb showed decreased mucositis, are you incorporating this agent? Please share your regimen and any tips.

What adjuvant therapy would you recommend for a patient with a sarcomatoid carcinoma of the submandibular gland after R1 resection?

No lymph node dissection. cN0

What is your approach in deciding to include the entire tongue or a smaller volume (tumor surgical bed + margin) for adjuvant radiation in oral tongue cancer?

Would you treat a smaller volume than the entire tongue for small, well lateralized tumor with indication for adjuvant radiation based on nodal status...

What volume would you treat with radiation in the setting of high risk oral tongue cancer completely resected with surgery and negative bilateral neck dissections?

For example pT4 and PNI, do you target the neck after a negative neck dissection? What factors influence the decision to treat: - surgical bed alone ...

How would you approach a patient with plasmablastic lymphoma of the nasal cavity s/p excisional biopsy to positive margins who is not a candidate for systemic therapy?

Medical Oncology did not recommend systemic therapy due to age/comorbidities. Would you consider radiation therapy? If so, what dose/fractionation?

How would you manage pleomorphic adenoma of minor salivary glands involving hypopharynx/larynx with positive surgical margin?

Would you offer adjuvant radiation? Dose/volume in postop setting?

When, if ever, do you recommend concurrent chemotherapy with definitive RT for early stage oral cavity squamous cell carcinoma?

Would you offer a 2nd generation anti-AR or abiraterone after progression on ADT in patients with metastatic AR+, HER2 expressing salivary gland carcinoma?

How would you recommend proceeding if there are no other actionable variants on NGS?

What is your approach to postoperative radiation for intraductal carcinoma of the parotid?

What are the factors, if any, that would prompt you to recommend radiation? Low grade vs High grade? Dose/volume?

For what OPX subsites would you consider NOT treating the high retropx drainage in the node positive neck?

Considering the high retropx drainage to be cranial to C1/hard palate.

Do you contour and constrain the sublingual glands?

If so, what is your dose constraint?

What are your recommendations regarding sexual activity for a couple when one of them is diagnosed with a HPV-positive oropharyngeal cancer?

How do you approach external beam RT to the thyroid bed for resected recurrent thyroid cancer in a patient with previous history of 150mCi of radioactive iodine?

Would you alter the esophagus, trachea, and cord constraint in any way?

How would you manage p16+ SCC of the oropharynx with bulky lymph nodes that are not responding as expected to standard chemoradiation?

Would you add a sequential boost to the node? If so, what dose would you recommend? If surgery is advised, how you would you time it with chemoradiat...

Would you offer definitive radiation for a T1N0 glottic larynx SCC in a patient with a history of RAI treatment?

Does the time from prior RAI affect your decision? How would you counsel the patient differently about the side effects, if at all?

For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?

Does it vary based on tumor site (oral tongue, FOM, gingiva, hard palate, etc.)?

How would you manage recurrent laryngeal papillomatosis requiring multiple resections of lesions with pathology never revealing any degree of dysplasia?

Would you offer definitive radiation, and if so, to what volume and dose/fractionation? Would your recommendation differ depending on if repeat resect...

How, if at all, does your approach to adjuvant chemoradiation differ with proton beam radiation vs. conventional photon radiation for H&N Cancers?

Is there data on efficacy or toxicity when chemotherapy is added to Proton beam therapy for head and neck cancer like there is data to support adding ...

For a lymph node negative nasopharyngeal EBV(+), cT3N0, what lymph node levels would you electively cover after a good response to induction chemotherapy?

Would you consider omitting contralateral neck radiation if this was a younger patient (i.e. <50 yo)?

How do you manage T1-2 SCC of the lip postoperatively?

In addition to positive margins, perineural/vascular/lymphatic invasion as listed by NCCN, would features such as close margins or high grade dysplasi...

Do you omit adjuvant radiotherapy in T4a laryngeal SCC with favorable prognostic factors?

According to the NCCN guidelines, there is a highly selected group of T4a glottic larynx patients that can undergo observation instead of postoperativ...

How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?

Encouraging aggressive PO intake in patients with swallowing dysfunction may place them at risk for aspiration pneumonia, especially risky if undergoi...

How would you treat a previously irradiated localized recurrence of an adenoid cystic carcinoma of the nasopharynx?

The patient previously underwent resection with close margins, adjuvant radiation to 66 Gy/33 fractions. Serial MRIs demonstrate progression with con...

What are indications for adjuvant radiation for well differentiated non-intestinal adenocarcinoma of the nasal cavity?

What volumetric dose constraints, if any, do you use for the mandible in the definitive setting for H&N cancers?

Are there certain portions of the mandible that you constrain more than others?

What mucosal surfaces do you commonly cover with HPV-positive squamous cell carcinoma of the head and neck of unknown primary?

What doses do you typically utilize? How does your coverage differ from your recommendation if this was an HPV-negative squamous cell carcinoma of the...

9 Answers available

What is the general approach for HPV+ OPSCC who present with distant metastases?

How do you decide if/when to treat the primary disease and when would you treat definitively?

For cisplatin ineligible patients with locally advanced head and neck cancer, would you consider RT + immunotherapy rather than RT + cetuximab?

In light of recent trials showing no difference in outcomes with RT+cetuximab vs RT+IO, does this potentially lead us to use immunotherapy in cisplati...

How do you manage an infection that occurs in the treatment field while under treatment?

Do you stop treatment? What if an abscess is also present?

How do you manage patients with persistent/recurrent disease in the neck >6 months after receiving definitive chemo-RT for p16-negative oropharyngeal SCC?

Does your approach differ from p16 positive disease? Assuming a biopsy shows active disease and the metastatic workup is negative, when would you off...

What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?

Would you offer adjuvant radiation to a low grade myoepithelial carcinoma of the soft palate with positive margins and no other aggressive features?

When treating sialorrhea in ALS patients, what treatment schedule do you use?

Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...

Is oral lichen planus a contraindication for immunotherapy in a patient with recurrent oral SCC?

There have been reports of pembrolizumab leading to lichen planus (my understanding is lichen planus pathophysiology unclear, but potentially autoimmu...

What were the historical radiation fields and dose for treatment of benign tonsillitis?

Does this ever affect your decision for treatment of current disease (eg likely radiation-associated sarcoma vs likely unrelated new oropharynx cancer...

Is it necessary to treat the entire larynx with intermediate or elective dose in a T1/T2 squamous cell carcinoma of the supraglottic or subglottic larynx?

How would you treat a postoperative pT4a NX larynx who had TL without node dissection and no suspicious nodes on pre-surgical imaging, specifying nodal volume and dose levels?

Are there elective neck regions you would choose treat to high risk (ie. 60 Gy) instead of low risk (ie 54Gy) dose? Are there risk favors that ...

Would you cover elective nodal regions in a patient with high-risk cutaneous SCC of the right medial forehead with clinically negative lymph nodes s/p WLE with graft?

If so, which nodal regions? SCC measures 5.5 cm, 2.0 cm thickness, closest margin 0.2 cm (deep), high grade, PNI+, LVSI+. Lymphadenectomy was deferre...

For head and neck cancer radiation requiring boost, do you plan using simultaneous integrated boost technique vs cone down technique?

Please share your institutional preference.

What is the significance of grade in OPSCC?

Do you take this into consideration when recommending treatment?

How do you manage locally advanced adenocarcinoma of the base of tongue?

Is the radiation therapy management equivalent to similarly-staged squamous cell carcinoma? Is there a preferred concurrent chemotherapy regimen? ...

How would you manage EBER positive (non-keratinizing) SCCa of unknown primary in the head and neck?

Would you treat it like an “endemic” NPX cancer with induction systemic therapy followed by CRT vs. CRT followed by adjuvant chemo vs CRT ...

In what situations would you place a prophylactic trach prior to radiation for head and neck cancers?

How would you treat an elderly patient with T1 glottic laryngeal cancer who refuses 28 fractions?

Would you offer SBRT (42.5 Gy in 5 fraction regimen off trial with or without Cyberknife)?

How do you approach radiotherapy after the patient has a facial nerve graft as result of tumor resection?

How long after grafting do you start radiation? Is there an optimal/recommended fractionation to preserve the graft?

When considering omission of elective nodal irradiation in the post-op head and neck bilateral dissected pN0 setting, what is considered an "adequately" dissected neck?

Contreras et al., Phase II results suggests that elimination of PORT to the pN0 adequately dissected neck may be safe for some head and neck primary s...

What is your approach to nodal coverage in a patient with lateralized adenoid cystic carcinoma (ie., buccal mucosa) with positive lymph node(s)?

Do you cover the entire ipsilateral neck or limit the field to involved nodal level(s), (assuming not chasing nerve for PNI)? Do you ever cover the c...

Is day 43 cisplatin 100mg/m2 needed after completion of RT in case of a delay related to neutropenia for locally advanced head and neck cancer?

Should the dose still be given after completion of RT?

Would you consider treating an adult patient with severe claustrophobia with daily anesthesia for 35 fractions if the goal is larynx preservation?

After multiple failed attempts with typical radonc trouble-shooting (ativan, cutting out mask, oxygen, etc)

How would you manage simultaneous locally advanced NSCLC and locally advanced head and neck cancer?

Would you treat lung and HN at the same time vs sequentially?

Do you employ a phrenic nerve dose constraint with conventional fractionation?

E.g. breast or H&N cancers when boosting the supraclav area.

In what situations, if any, is it appropriate to forego surgery for nodal recurrence (intraparotid and/or ipsilateral neck) of cutaneous SCC and definitively treat with chemo-RT?

Assuming patient is medically operable, would you always advocate for surgical dissection? If so, how to you approach post op radiation (and chemo). ...

Do you require both biopsy of the primary in addition to nodes in your practice for HNC?

Do you routinely use mannitol to prevent cisplatin-induced nephrotoxicity?

If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?

What dose/fractionation would you use to treat a papillary thyroid cancer with bulky cervical adenopathy and laryngeal invasion with impending airway obstruction that is refusing laryngectomy and surgical management?

What approach do you take to determine dose constraints for conventionally fractionated reirradiation of the head and neck?

Do you have formal constraints and evaluate cumulative doses on the composite plan? Do you use traditional constraints but account for repair?

When would you recommend observation and withhold adjuvant RT in resected esthesioneuroblastoma?

How would you manage a symptomatic marginal zone lymphoma of the base of tongue causing globus sensation also incidentally found to have squamous cell carcinoma in situ?

Assuming additional workup including more extensive biopsy and nodal evaluation shows no evidence of invasive squamous cell carcinoma. Would this cha...

Would you offer EBRT for an unresectable and growing substernal goiter compressing the trachea, esophagus, and aorta that has been refractory to RAI?

Have a patient with a multi-year history of a growing substernal goiter. There is mass effect on the trachea, esophagus, and aorta. He is experiencing...

Have you utilized silicone-based film-forming dressings to prevent, minimize, or treat radiation dermatitis?

Please share your patient selection criteria and experience.A recent study in H&N patients showed superiority of the StrataXRT gel over standard o...

What criteria does your institution use to indicate patient is ready for PEG tube removal?

How do you approach the treatment of synchronous primary pancreatic and base of tongue cancers?

Hypothetically not an ideal surgical candidate due to weight loss. Both cancers are non-metastatic and resectable if disregarding other cancer and com...

How would you manage a medically inoperable patient with an invasive squamous cell carcinoma of the oropharynx and extensive adjacent leukoplakia harboring pathologically-proven in situ disease?

What is your radiotherapy approach? How large is your treatment field, and for the leukoplakia/in situ disease, what is your dose?

What are your top takeaways in Head & Neck Cancers from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...

Would you be comfortable with patients taking Juven protein powder during head and neck radiation?

Juven protein powder is good for healing and helps with mucositis but has high amounts of antioxidants. Is that of concern while patients are undergoi...

What is your recommended way of managing a locally advanced bulky base of tongue (BOT) p16 negative squamous cell carcinoma extending into multiple structures of the supraglottic larynx?

Would you recommend concurrent chemoradiation (organ presrevation) vs. surgery (laryngectomy/pharyngectomy and extensive base of tongue resection) and...

How would you treat an elderly patient with a well-lateralized large (ie. cT3) node negative oral tongue cancer, who is not felt to be a surgical candidate?

Do you routinely offer doxycycline or minocycline prophylaxis for cutaneous reactions to EGFR inhibitors such as cetuximab?

If you do not use prophylaxis, what skin care strategy do you employ?

How do you manage unresectable granular cell tumors of the orbit?

Have you ever used sodium alginate to treat radiation-induced mucositis of the upper digestive tract?

Sodium alginate, an ingredient found in ice cream, is now being used in Japan to reduce RT-induced esophagitis. Anecdotally, a daily quart of ice crea...

Can the tracheostomy be reversed after completion of chemoradiation for laryngeal cancers?

At what disease free interval is the safest to consider this?

For a T1 true vocal cord cancer that is p16+ would you use standard dose (63 Gy in 28 fx) or use a lower dose of radiation?

Would you consider head and neck RT for a patient with pre-existing carotid blowout due to tumor involvement?

How do you manage high grade dysplasia of true vocal cord a yr after radiation to the larynx for T1 lesion?

What elective areas are you comfortable omitting in the N0 neck for NPC?

In what N1 H&N patients, if any, would you consider treating the gross disease (primary + involved node) only without elective nodal radiation volume with definitive intent in order to reduce toxicity?

Can elective nodal RT be omitted for select patients with T2-4N1 head and neck cancers with multiple commodities and poor KPS with life expectancy <...

What dose and fractionation do you use in the setting of head and neck reirradiation?

Does your recommendation change depending on the disease-free interval?

Would you offer adjuvant capecitabine in a patient with nasopharyngeal carcinoma who has had cisplatin - gemcitabine induction followed by chemoradiotherapy with cisplatin?

Stage is cT4N2M0.

How would you approach a patient with progressive muscular dystrophy affecting the pharyngeal muscles who needs treatment for a p16 positive base of tongue cancer with bilateral neck disease?

Would you avoid radiation/prefer surgical approach? Tighter pharyngeal constraints?

Do you treat the ipsilateral neck and primary site for a resected skin cancer with parotid mets?

If the only indication were the parotid mets (primary site resected with no high risk features) would you treat the parotid and neck (assuming skin ca...

What adverse features would prompt you to give post-TORS radiation therapy to completely resected early stage (T0-2) p16+ tonsillar cancer?

Is single node >3cm sufficient for you to offer radiation, or do you have a different size cutoff? What other factors (such as those listed in NCCN...

How would you approach a patient with well controlled metastatic lung cancer who develops a new primary P16 positive oropharyngeal squamous cell carcinoma?

Is it reasonable to dose de-escalate since survival will likely depend on the metastatic lung cancer?

How do you decide on the elective radiation volume when treating a lateralized node negative non-tongue oral cavity cancer with definitive chemoRT?

E.g. buccal mucosa, maxillary vestibule tumors Particularly what do you levels of the contralateral neck do you include? What factors (T stage...

What is the role of MRI in target delineation of radiation therapy for non-NPC H&N cancers?

Do you utilize MRI to aid in planning for oropharyngeal primaries?

How do you select which patients with H&N primary tumors benefit from proton therapy?

Would you take any precautions of plan radiation therapy differently for a patient with head and neck cancer who has active Bullous Pemphigoid in the mucosal area that will be radiated?

How do you approach radiation volumes and dose for unknown primary presumed minor salivary gland carcinoma?

How would you approach the parotid volume for a PET avid intra-parotid node when planning definitive chemo radiation for a locally advanced squamous cell carcinoma of the oropharynx?

Is biopsy necessary to confirm disease? Would you include the entire parotid in the intermediate risk volume?

How do you treat a low grade mucoepidermoid carcinoma with unkown primary site?

If pathology review is done and all imaging scans including CT scan, PET scan and MRI have come back without a primary site, is it reasonable to close...

What is the significance of entrapped nerves present on pathology for oral cavity cancers?

How does this affect management?

What factors, if any, (such as microscopic ENE (<=2 mm) or larger nodal size (e.g., >4 cm)) would prompt you to treat the contralateral neck for oropharyngeal cancers otherwise eligible for unilateral radiotherapy?

From my review of literature, the rate of contralateral neck failures with ipsilateral radiotherapy for lateralized tonsil T1-2 N2a disease is very lo...

How do you sequence I-131 and external beam radiation therapy after thyroidectomy for locally advanced thyroid cancer?

Do you utilize both therapies? Which should come first?

How do you typically prescribe dose to a PTV for standard IMRT plans?

Would you offer a RET inhibitor for a RET-mutated medullary thyroid carcinoma after R1 resection in a patient with elevated calcitonin?

What factors may favor RET inhibition versus observation?

Would you recommend adjuvant radiotherapy for recurrent paraganglioma with lymph node involvement treated with salvage neck dissection with no residual disease?

Would the rate of growth, number of nodes involved, size of nodes, ENE etc. affect your decision? What volume and dose would you recommend?

Would you recommend adding Debio 1143 to high-dose cisplatin chemoradiotherapy in high-risk locoregionally advanced squamous cell carcinoma of the head and neck?

Based on the results of the phase 2GORTEC study reference; Sun et al., PMID 32758455.

Which MR simulation sequences do you prefer for head and neck RT?

Which sequences/protocols do you find most useful for target delineation (primary? nodes?). Do you use contrast? If you had to choose a few to limit t...

Are there scenarios in which you would add nimotuzumab to cisplatin based concurrent chemoRT to treat locally advanced head and neck cancer?

Would differentiating between embryonal vs alveolar rhabdomyosarcoma of the nasal cavity change your neoadjuvant chemotherapy regimen or make you consider neoadjuvant radiation in a locally advanced pleomorphic RMS?

40 yo adult patient with a~6cm mass with concern for skull base bony involvement (group III and stage III, no nodal involvement )

How are you using circulating tumor DNA in your clinical decisions for HPV-associated OPSCC?

How would you manage a cT2, N0 poorly differentiated mucoepidermoid carcinoma with sarcomatous features/carcinosarcoma affecting the soft palate?

How do you decide when to electively cover ipsilateral level IB or V in a node positive neck?

Do you always cover these areas of ipsilateral neck is positive? Does it depend on nodal level involved, primary site (oropharynx vs. larynx/hypophary...

What dose-fractionation do you utilize when treating at-risk and elective lymph node levels in patients with HPV-positive oropharyngeal squamous cell carcinoma?

Do you reduce the dose in such cases? Do you treat with six fractions per week similar to RTOG 1016 (w/ or without chemo)?

What is your approach to postoperative radiation therapy in a patient with INTERMEDIATE grade early stage (I/II) mucoepidermoid carcinoma of the parotid and no other risk features?

Would you always radiate? If not, when do you feel comfortable with observation after surgery?

What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?

Resected small bilateral tonsil SCC & base of tongue SCC. The patient received 6 cycles of BEP 30 years ago for testicular cancer, and suffers fr...

What is your approach to prescribing gabapentin for oral mucositis prophylaxis during chemoradiation?

Has your practice changed based on the randomized, phase 3 study showing prophylactic gabapentin is not effective? Please share your thoughts and exp...

When would you add an extra radiation dose to compensate for treatment breaks?

Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate? Is there a decent equatio...

When would you consider hyperbaric oxygen for skull base necrosis or temporal lobe necrosis following CNS/HN RT?

What is the general treatment paradigm for resected mucosal melanoma of the head and neck with respect to targeting and dosing?

Does HPV-status play a role in selection of immune checkpoint inhibitors in upfront treatment of metastatic head and neck cancer?

How do HPV-positive patients respond to ICI compared to HPV-negative in your experience?

How would you approach post-op radiation recommendations in patient who had neoadjuvant chemotherapy for locally advanced oral cavity cancers (oral tongue) who have a complete pathologic response (pCR) after surgical resection?

Would a complete pathologic response impact your dose or decision to treat in absence of studies?

How you do approach adjuvant radiation recommendations (RAI and EBRT) for papillary thyroid carcinoma, tall cell variant status-post total thyroidectomy?

How long after completion of radiation therapy should patients continue fluoride treatment for dental health?

Is it reasonable to omit nodal RT in an elderly patient with T3N0 SCC of the glottic larynx?

If the glottic cancer is T3 due to thyroid cartilage involvement, can nodal RT be omitted?

Are you using the commercially available Naveris assay for HPV+ OPX cancers in your practice?

Based on the JCO 2020 paper, how are you using this information? I understand there is no data to change management and most of us will be hesitant t...

When do you use a bite block for H&N cases?

When do you include the neck in the RT field for resected thyroid cancer?

What are your indications for including the contralateral neck when planning postoperative primary and ipsilateral elective neck radiotherapy for a well lateralized buccal squamous cell carcinoma?

The 2019 ASCO guideline suggests contralateral neck radiotherapy for T3-T4 oral tongue and/or floor of mouth primary sites or tumors approaching midli...

In which oropharynx patients would you recommend TORS vs upfront RT or chemo-RT?

What clinical criteria would make you prefer TORS as the initial treatment approach?

How would you treat a head and neck patient who had definitive chemoradiation who develops an isolated mediastinal lymph node recurrence?

Do you offer definitive treatment? Systemic therapy alone since it's metastatic?

What dose do you recommend in adjuvant setting following R0 resection of Sinonasal undifferentiated carcinoma (SNUC) involving paranasal sinuses/nasal cavity and close proximity to eyes?

Additionally, what dose constraint(s) do you use to avoid issues with vision?

Would you recommend the addition of chemotherapy in a patient with locally recurrent, unresectable squamous cell carcinoma of the head and neck for whom repeat radiation is planned?

Patient received full dose concurrent cis + RT previously.

How do you approach staging and treatment for a p16+ nasopharyngeal SCC?

How do you stage? Like nasopharynx or p16+ oropharynx? Do you treat it like npx ca with chemo xrt + adj chemo or like opx p16+ with definitive chemo ...

Do you routinely cover level IA lymph nodes for advanced BOT tumors extending into floor of mouth or oral tongue?

Or do you only treat to IA if the primary is in an oral cavity location?

Is it safe to offer head and neck radiotherapy to a patient with a diagnosis of porphyria such as erythropoietic protoporphyria or porphyria cutanea tarda?

For head and neck cancers do you ever reduce PTV coverage in the post-op setting to meet an OAR constraint?

While likely dependent on the case, do you ever view CTV coverage alone as sufficient in certain areas to meet an OAR constraint such as parotids? Thi...

How do you manage anaplastic thyroid cancer that is progressing through radiation therapy?

Can the radiotherapy dose be reduced in patients with head and neck cancer who have a complete response to induction/neoadjuvant chemotherapy?

Assuming a clinical trial is unavailable, would you consider tazemetostat in a patient with metastatic INI1/SMARCB1 deficient sinonasal carcinoma?

Has anyone tried this approach with success?

What volumes do you cover when delivering salvage radiation for a contralateral neck recurrence after upfront ipsilateral neck radiation for tonsillar cancer?

Do you treat just gross disease with margin or electively treat levels Ib-V? What if the patient is elderly and there is a pacemaker in level IV...

What is your approach to post-operative radiation (when to offer, volume, dose, fractionation) for a primary intraosseous squamous cell carcinoma (PIOCC) of the head & neck?

Is adjuvant RT necessary for a completely resected pT1/2 N0 disease with negative margins?

What features or presentations would prompt you to offer radiotherapy for paraganglioma vs. continued surveillance?

Aside from symptomatic disease, is there a certain growth cutoff or other criteria that would be a trigger for treatment?

Would you treat the contralateral neck in post-op parotid salivary gland malignancy with multiple positive nodes ipsilaterally?

The experience by Hsieh et al. from submandibular gland carcinoma shows an 11% contralateral nodal recurrence. If you had a parotid gland malignancy ...

What are the advantages and disadvantages of concomitant versus sequential boost for treating cancers of the head and neck with IMRT?

How do you account for previous dose from I-131 when delivering external beam radiation therapy near the thyroid bed?

Would you electively cover the neck for intermediate grade mucoepidermoid carcinoma of the salivary gland?

How has advanced imaging, especially PET/CT, changed your treatment volumes and approach for a head and neck cancer of unknown primary?

For example, much of the data on treatment volumes treating the head and neck with an unknown primary are from the pre-PETCT era. While the posi...

What dose constraints would you use for head and neck SBRT in a previously untreated field?

BR-001 allows treatment of oligometastatic disease in cervical lymph nodes but provides few dose constraints for SBRT in the head and neck. (Most of t...

What is your experience and practice patterns when treating midline NUT carcinoma of the head and neck?

Do you routinely include elective nodes in your radiation volume? How, if at all, does your approach to NUT differ between various sinonasal carcinom...

How would you approach a small, node-negative (cT1-2N0) nasopharyngeal cancer in a patient with prior H&N cancer treated with surgery and radiation?

Do you always radiate the elective neck in addition to the primary site? If they had one-sided neck dissection and radiation for their prior cancer, ...

Would you offer adjuvant chemoRT to a patient who underwent neck dissection for a T0N1M0, p16+ head and neck squamous cell carcinoma?

Lymph node is 4.5cm with no reported ECE. Does the size of the LN or presence or absence of ECE affect your decision?

Should chemoradiotherapy to primary and neck be offered to patients with Stage IVC nasopharyngeal carcinoma with limited osseous disease?

What are the data for loco-regional and distant recurrence rates with and without local therapy? What is the OS advantage?

What is the best treatment for a squamous cell carcinoma of the palpebral conjunctiva with persistently positive margins after resection?

How would you approach synchronous early stage NSCLC adenocarcinoma and locally advanced symptomatic squamous head and neck cancer that is deemed nonresectable upfront?

Would you prioritize the head and neck cancer or treat the lung cancer first with SBRT to take care of it first? How about if there is mediastinal inv...

What cumulative dose would you allow the pharyngeal carotid to receive for a course of reirradiation for a retropharyngeal node?

How do you adequately balance treating a gross retropharngeal lymph node and limiting dose to the carotid? What would you quote the risk of carotid bl...

What is your preferred approach to adjuvant therapy for a Masaoka Stage III thymic carcinoma after R1 resection?

Would you elect for concurrent chemoRT or RT alone?

How would you treat a metastatic small cell carcinoma of the larynx that is locally progressing on cisplatin/etoposide?

What dose and fractionation would you use, and would it differ from other types of H&N cancers? Would you consider Quadshot scheme?

What do you use for IGRT for definitive H&N IMRT treatments?

What are the advantages and disadvantages or using films vs. CBCT? What are you looking for in each case? How often should you CBCT, and what are the...

How would you manage a high grade acinic cell carcinoma of the parotid with isolated recurrence in the ipsilateral neck s/p salvage resection?

Patient previously had adjuvant radiation to the tumor bed only. What is your radiation volume and dose? Any elective nodal levels (ipsilateral vs. ...

Would you recommend induction chemotherapy such as TPF to a patient with locally advanced sarcomatoid carcinoma of the nasal cavity?

Or would you recommend upfront resection as long as borderline resectable?

Would you consider orbit sparing treatment for a lacrimal gland carcinoma?

In what situations would you advocate for orbital exenteration vs orbit sparing surgery with adjuvant radiation (particle therapy)?

Are there any circumstances in which you would recommend adjuvant chemoradiation for resected olfactory neuroblastoma?

Is it safe to deliver SBRT with concurrent immunotherapy to head and neck sites of progressive metastatic disease?

What doses and constraints do you use?

Would you electively treat the neck for a completely resected parotid carcinoma ex pleomorphic adenoma with negative lymph node sampling?

For a R0 resected large inverted papilloma of the maxillary sinus with invasion into multiple surrounding structures but only a small malignant portion, would you cover the entire papilloma extent or only the malignant portion post-op?

What dose/fractionation would you utilize?

Are there any preferred chemotherapy regimens for Stage IV NUT carcinoma?

Is there any role of radiation therapy for these patient for symptomatic relief?

When, if ever, would you trace the facial nerve back to the base of skull for a pleomorphic adenoma of the parotid?

Is this necessary given that they are benign lesions? What factors would make you consider tracing the facial nerve?

How would you design your post-op radiation field for pT4a laryngeal SCC with subglottic extension s/p TL, who has a TE fistula?

(1) How inferior would you take your level VI lymph nodes? (2) Would you cover the TE fistula/esophagus area?

For which head and neck cancer patients do you or your dental colleagues recommend fluoride?

When do you start fluoride treatment?

How would you treat patients with advanced head and neck cancer with involvement of upper mediastinal lymph nodes?

Do you recommend definitive chemoradiation? What is your treatment volume, dose, fractionation?

When you treat postop head and neck cancer, do you typically add a CTV margin to the delineated postoperative bed, or just treat postop bed plus PTV margin?

Would you offer adjuvant radiation for a grade 1 osteosarcoma of the mandilbe with close margins following surgical resection?

What margin would you consider to be necessary to omit radiation?

How do you manage a patient with isolated local recurrence of head and neck cancer with a pharyngocutaneous fistula within previously irradiated field?

What is your approach to adjuvant radiation in SCC of oral cavity with exposed bone following mandibulectomy and reconstruction?

What can be done to promote wound healing? How far down would you delay radiation? Would you start at 6 weeks anyway if certain high risk features a...

What is your preferred treatment for locally advanced poorly differentiated carcinoma of the nasopharynx with bulky neck nodes that is EBER negative and p16 negative?

Would you consider induction: TPF vs cis/gem or would you proceed with chemoradiation with cis/RT and consider adjuvant cis/5FU?

Do you offer adjuvant androgen deprivation therapy for AR+ salivary ductal carcinomas treated with curative intent?

If so, how do you sequence it? Would you consider before adjuvant radiation vs concurrent with adjuvant (chemo)radiation vs after adjuvant radiation? ...

Do you give Cetuximab concurrently with SBRT for recurrent head and neck cancers previous treated with definitive radiation?

Addition of Cetuximab with re-irradiation SBRT in H&N Ca was mentioned previously: https://www.themednet.org/question/1936 https://www.themednet...

How would you treat an ipsilateral retropharyngeal node recurrence in a patient with history of early stage oropharyngeal cancer managed by surgery and no previous adjuvant radiation?

What target volume (node with margin only or include other areas) do you treat and to what dose? What if patient had previous radiation? Any concurre...

Would you include ipsilateral nodes in adjuvant RT for bulky Mammary Analogue Secretory Carcinoma of salivary gland?

Histology 1st described 2010, and acknowledged by WHO 2017. Probably previously usually diagnosed as Acinic Cell Carcinoma. In one source (Chiosea SI ...

How would you manage a imaging suspicious undissected (ipsilateral) lymph node in the setting of post-op RT for an oral cavity cancer with extensive nodal disease and ECE?

How would you manage a clinically suspicious (CT/PET) but undissected (ie., level V or paratracheal) lymph node in the setting of post-op RT for an or...

What planning techniques and constraints do you use when treating H&N cancer with VMAT as it relates to arcs that sweep through shoulders that ride high?

I am curious if anyone has tried to split the arcs in a way that minimizes dose being pumped from the outside edge of the shoulder to reach low cervic...

How would you manage the primary site of a metastatic nasopharyngeal cancer showing cCR after systemic therapy?

Would you add radiation, if so any concurrent systemic therapy? Would you consider hypofractionation, if so, what dose/fx and reference for constrain...

In a patient with stage III-IV p16+ oropharyngeal cancer undergoing definitive CRT who is unable to maintain nutrition, would you rather consider stopping treatment early (to an investigational de-escalated dose) or insert a feeding tube/take treatment breaks in order to complete the full dose?

In what head and neck subsites, if any, would you recommend adjuvant radiation s/p high quality neck dissection if pN1 disease (single ipsilateral LN <3cm) was the only risk factor?

Can the ASCO guidelines for oral cavity be applied to other head/neck subsites? NCCN, ASTRO, and ASCO guidelines vary widely and depends on the prima...

When treating with adjuvant radiation to the neck after dissection for a nodal recurrence from a nonmelanoma cutaneous malignancy, would you include the primary tumor resection bed in the field if some time has passed since the primary resection?

Would you always/never include the initial tumor bed? Is there a time interval or any other factors that would affect your management?

How would you (non-surgically) approach and treat two synchronous distinct oropharynx T1-T2N0 primaries with definitive RT?

Would you add concurrent systemic therapy with radiation due to concern for field cancerization?

Would you add concurrent chemotherapy to definitive radiation based on suspicion for extranodal extension (ECE/ENE) on imaging (adjacent fat stranding) for a clinical T1-2N1 (single node < 3cm) oropharyngeal cancer?

If no, would your recommendation change if there is obvious extranodal extension with invasion of adjacent muscle? Does p16 status affect your d...

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 bou...

Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?

In the post-op setting, would you delay 1 week even if it took them out of the 6 weeks post-op window? Meaning the loading dose of erbitux was given d...

Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?

Would you have reservations in treating patients with breast, GI, or pelvic malignancies with radiation alone or concurrent chemoradiation?

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 54 Gy or 60 Gy for level IV? Or do you always take...

For a patient with H&N squamous cell carcinoma who underwent salvage neck dissection for residual disease following primary chemoradiation with weekly cisplatin, do you offer any adjuvant therapy thereafter if extranodal extension is found?

In primary surgical resection, ENE on surgical path would be indication to add adjuvant chemoradiation. After progression through definitive chemoradi...

How would you approach therapy for a nasal high grade neuroendocrine tumor with ipsilateral local cervical adenopathy?

Is the COVID-19 pandemic affecting your choice of high dose versus weekly cisplatin for definitive concurrent chemoradiation for HPV negative head and neck cancer?

Would you ever utilize quad shot specifically for a large SNUC?

Do you include the clinically negative contralateral neck in your field for a lateralized oral cavity who has N2b disease after LND?

What dose level do you take it to if it is a buccal mucosa/retromolar trigone? Any additional factors that would change your decision?

How would you manage a p16 positive small cell carcinoma of the tonsil?

Would you consider PCI?

How would you treat laryngeal neuroendocrine carcinoma?

If advanced stage do you follow same guidelines as Scc? Do you use same Cth regimen? Role of total laryngectomy ?

Is a close but negative for margin (<5 mm) an indication for adjuvant radiation in oral cavity squamous cell carcinoma?

NCCN guidelines lists adverse features as positive margin, but does not appears to include close margin. If felt to be an indication similiar to a pos...

How should masticator space involvement be defined: anatomically or by AJCC's vague definition with regards to Nasopharynx Cancer?

This has a big impact on treatment volume delineation if one schema classifies a lesion as T2 and the other leads to classifcation as a T4. In the T4...

How would you manage progressive diffuse (both cords and arytenoid) high grade dysplasia of the larynx, with no in-situ or invasive disease on biopsies?

Leukoplakia is present throughout but no exophytic masses seen. Is radiation an option (dose/fractionation)? Surgery? PDT?

How would you treat a synchronous oropharyngeal cancer and proximal esophageal cancer?

What is your preferred concomitant chemotherapy FOLFOX? Carbo-Taxol? Which dose would you give? SIB?

How do you manage intractable hiccups from radiation?

Have you found any of the more common medical treatments (chlorpromazine, baclofen) to be most effective in the setting of throacic radiation or head ...

In the setting of adjuvant treatment for locally advanced oral cavity cancer, would you offer altered/hypofractionated courses for elderly patients with lower functional status?

Any experiences using 50/20 with a break, or 30/5 in the adjuvant setting?

How do you approach multiply recurrent early-stage oral tongue SCC despite multiple resections?

At what point do you hold surgery and switch to definitive chemoradiation? What is your treatment volume? If additional surgery is preferred, do you...

How would you best manage a medically inoperable oral cavity squamous cell carcinoma that is locally advanced and node-positive with likely extranodal extension?

Consider 6 fractions weekly chemoRT? Add cetuximab to chemoRT? Proton boost? Induction chemo prior to chemoRT? Interstitial H&N brachytherapy boos...

How would you approach patient with metastatic anaplastic thyroid cancer with NGS revealing only ARID1A mutation?

Do you routinely use IMRT to spare the carotids for early-stage glottic cancer?

What constraints do you use if using IMRT/VMAT?

How do you approach H&N radiation in a patient who recently had carotid endarterectomy (cancer incidentally found during surgery)?

What constraint to the repaired carotid artery and bovine pericardial tissue used to patch the defect? How long should we wait from surgery to start o...

How would you treat a sebaceous carcinoma of the orbit definitively with radiation, if they refuse exenteration?

Does your recommendation change if the patient is elderly? Dose/fractionation/volume? Systemic therapy?

Is it safe to deliver definitive radiation for a solid tumor malignancy (ie H&N) concurrently with maintenance lenalidomide/Revlimid for multiple myeloma?

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 ...

Do you constrain dose to the muscles of mastication in definitive and/or post-op HN RT to lower the risk of trismus?

What dose limits do you use and in which situations will you exceed them? How do you counsel your patients on risk of severe trismus and how do you ma...

What is your approach to adjuvant radiotherapy of laryngeal cancer after laryngectomy and flap reconstruction?

Do you limit the delineation to the initial tumor bed, or do you delineate the whole body of the flap (eventually sparing the pedicle of the flap)? A...

What is your preferred dose and fractionation for verrucous carcinoma of the larynx?

PMH O'Sullivan et al used 50Gy/20fx or 60Gy/25fx https://pubmed.ncbi.nlm.nih.gov/18707828/ Or extrapolate from SCC larynx using 2.25Gy/fx to 63-65.2...

When would you consider adjuvant chemoradiation in a patient with esthesioneuroblastoma?

Would gross ENE or R1 resection trigger you to consider adding chemo? If so, do you use weekly cisplatin or cisplatin/etoposide?

Would you offer, and what data would support, the use of an FGFR inhibitor in FGFR3 mutated anaplastic thyroid cancer?

How do you approach postoperative radiation for small oral cavity cancers cases with limited risk factors?

Are there situations where you skip radiation despite risk factor(s) commonly listed or do you always give adjuvant radiation? For example, for FOM p...

What is your approach to definitive RT for nasal vestibule squamous cell carcinomas?

Would you do IMRT or 20MeV/6MV electron/photon mix (traditional moustache field)? When do you treat LNs? T3/T4? What LN levels would you include? le...

How would you treat a second HPV related oropharyngeal squamous cell cancer in a patient previoulsy treated and cured of a HPV related SCC of the tonsil treated with chemoradiation?

What treatment would you initiate post-operatively for patients with de novo metastatic follicular thyroid CA requiring laminectomy for cord compression?

In addition to TSH suppression, would you opt for RAI, targeted treatment based off NGS, or lenvatinib?

How are you approaching head and neck re-irradiation cases if the recurrent cancer has been resected but with high risk features such as ECE etc.?

Can you comment on fractionation schedules with and without chemotherapy or immunotherapy.

Why is pT3 not a PORT indication for glottic larynx in the NCCN guidelines?

NCCN list T3 as an indication for PORT for all head/neck subsites including supraglottic larynx with the sole exception of glottic larynx. (Some other...

Is Guillain Barre syndrome a contraindication for radiation therapy?

Have you seen worse toxicities in these patients?

How much subglottic extension from a primary glottic tumor would make you treat the regional lymph nodes?

Degree of subglottic extension is often difficult to determine from office scope examinations and ENTs do not always include this. Do you have any tip...

How would you modify adjuvant radiation for oral cavity SCC based on the presence of sarcomatoid features?

How would you treat recurrent unresectable sarcoma in previously irradiated maxillary region, with no distant metastatic disease?

How will your management of head and neck cancers change with the COVID-19 pandemic?

Are you employing more or less primary chemoRT v. surgery for some cancers? Are you dose de-escalating? What are issues radiation oncologists should b...

How would you treat a pt with cT2N0M0 SCC of the supraglottic larynx (good PS, swallowing function) with a bulky primary tumor?

Older data suggests that local control with RT alone for supraglottic tumors >6cc is fairly low. Would you employ altered fractionation (what dose...

In what situations (if any) would you recommend ENI for a low grade parotid mucoepidermoid carcinoma?

What levels would you cover and to what dose?

Do you utilize consolidative RT for oligometastatic HPV positive head/neck cancer with stable disease on immunotherapy?

If so, do you have a threshold for number of involved sites i.e. X lesions in Y organs, etc.

Is there a role for post operative elective nodal irradiation in locally advanced sinonasal, clinically N0, intestinal type adenocarcinoma (ITAC)?

What is your general approach to this rare histology?

How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?

How would you treat a skull based chordoma in a pediatric patient?

If proton therapy is not available would you consider radiosurgery? How would your management differ if residual disease is present?

0 Answers available

Do you use bite block during radiation treatment for base of tongue (BOT) cancer?

How does your setup differ from oral cavity cases?

What is your approach to definitive radiation for p16+, cT2N1M0 (AJCC 8th ed) base of tongue SCC?

Definitive RT only? Concurrent chemo-RT? Technique, dose (for radiation and chemo, if any), fractionation?

How do you treat a large, resected ex pleomorphic adenoma with unknown margin status due to tumor fragmentation?

Would you observe or radiate?What volume, dose, fractionation would you use? Systemic therapy?

Do you constrain the dose to the oropharynx, parotids, or oral cavity when planning HA-WBRT?

A HA-WBRT patient developed brisk mucositis on the soft palate at fraction 8/10

What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?

How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.) Would you use Cetuximab? Altered fractiona...

Would you treat extranodal extension WITHIN a matted nodal mass differently than at the surface in the postoperative setting for H&N cancer?

In the case of a nodal mass of several nodes matted together due to ENE but without apparent ENE at the surface, does your management change? Is ENE ...

For patients with locally unresectable/metastatic head and neck cancer who achieve complete response to chemoimmunotherapy, how do you manage their subsequent care in terms of continuing therapy vs. close monitoring?

Is stage N2a alone an indication for PORT in oropharyngeal squamous cell carcinoma with no other adverse features?

In a case with negative margins, T1-2 primary, no ECE, no perineural invasion, etc, is adjuvant radiotherapy indicated based on N2a stage?

How would you treat an unresectable eccrine carcinoma of the skin of the face?

Is the approach similar to squamous cell carcinoma?

In what situation, if any, should a proton boost be used to boost gross disease in head and neck cases?

How can this be done logistically to coordinate the proton boost off site? Should everything be done up front? How are the logistics regarding plannin...

What head and neck subsites would you treat for a SCC of multiple ipsilateral neck nodes (clinical ECE, no contralateral nodes) with unknown primary origin site despite full workup?

Would you spare contralateral neck? Does your recommendation change depending on p16 status?

What dose and fractionation would you use for definitive intent radiation therapy for a metastatic melanoma of the maxillary sinus?

How would you manage locally advanced head and neck patients getting definitive chemoradiation who show progression halfway through treatment?

Do you alter treatment and/or fractionation?

Are there particular adjuvant therapy considerations for locally advanced HNSCC patients who are found to have metastatic involvement of cystic lymph nodes during surgery?

Are there increased concerns of infection or fistula formation with such nodes?

Is postoperative radiotherapy indicated for a primary parotid gland melanoma?

Would there be any indication for postoperative RT if cervical lymph nodes are negative?

For patients with p16+ SCC of a cervical lymph node subsequently found to have an oropharyngeal mass on imaging, is it necessary to biopsy the primary site prior to proceeding with definitive RT?

What CTV expansion volumes would you recommend for a large, unresectable, symptomatic desmoid tumor of the neck?

Would you use general sarcoma expansions or would smaller expansions like the ones in head and neck would be reasonable?

How would you approach a locally advanced, node positive oral cavity squamous cell carcinoma of the H&N with cCR after induction chemotherapy?

Is surgery still indicated? If no surgery is pursued, (how) would you deliver consolidative radiation therapy?

Would you radiate a multiply recurrent basal cell adenoma of the parotid?

Is there data to show efficacy of radiation in this situation? What dose/fractionation/volume?

How do you manage dental extractions in a patient getting reirradiation to the mandibular area?

Any dental extraction of the mandible could lead to healing problems and thus delaying reirradiation.

Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?

Is there data to support every 3 week dosage v. weekly? https://ascopost.com/news/march-2022/postoperative-weekly-vs-every-3-week-cisplatin-i...

How would you treat maxillary ameloblastic carcinoma s/p R1 resection and perineural invasion?

What would be your radiation dose and target volumes? Concurrent chemo? Would you offer neck node radiation if no neck dissection was done?

Should additional radiation be added to the total course in a HN patient who has an extended break during treatment?

Following oral cavity radiotherapy, how do you advise patients on ongoing bisphosphonate therapy and the risk for osteonecrosis?

Do you encourage patients to take a break from/stop taking Fosamax or similar medications for their osteopenia or osteoporosis in order to prevent dev...

How would you approach a resectable and isolated ''in-field'' local recurrence of head and neck cancer detected mid-way through adjuvant radiation?

What if this recurrence is not resectable?

In which situations can you spare the contralateral neck for oropharyngeal carcinoma?

How do you treat a patient with synchronous locally advanced lung and head and neck cancers?

Does the availability of first line checkpoint inhibitor therapy affect your treatment decision?

How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?

Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristic...

Would you treat T1a glottic cancer with single vocal cord irradiation using IGRT?

The traditional 2-field parallel opposed field technique irradiates the whole larynx to the same dose and includes unaffected structures. This ...

How do you balance target coverage with tolerances of the ipsilateral eye structures and the risk of vision loss in advanced head and neck cancers?

i.e. T4 sinus tumor with advanced orbital invasion? Would your opinion and approach change in the event the patient responds favorably to neoadjuvant ...

What is the role of neoadjuvant chemotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma?

In early well-lateralized SCCA of the tongue (pT1-2N0), should the contralateral neck be radiated?

In what situations do you treat the elective neck for patients with resected esthesioneuroblastomas?

Are you covering the tracheostomy site with a surgical mask due to COVID-19 to protect the therapist?

Please see this article for referrence https://www.sciencedirect.com/science/article/pii/S0167814020301638

How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?

Aside from smoking cessation, what interventions have you found useful to manage patients with chronic symptomatic laryngeal edema? Steroids seem to b...

Why is accelerated hyperfractionated RT still being performed in NRG trials such as HN005?

Didn’t 0129 establish no difference between conventional vs Accelerated RT with the same Cisplatin regimen? Are there still thoughts of benefit ...

Do you give two or three cycles of cisplatin to patients with H&N squamous cell carcinoma receiving chemoradiation with Q3 week cisplatin?

Would you consider low dose lenvatinib or dabrafenib/trametinib for rapidly progressive RAI refractory thyroid cancer with BRAF V600E mutation in a patient in whom you are concerned about tolerance of full dose lenvatinib?

Such as in patients who are elderly or have borderline performance status

In the wake of the COVID-19 pandemic, are there any hypofractionated regimens (without concurrent chemotherapy) that could be utilized for head /neck cancer in a post operative setting?

How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

Are you routinely considering treating p16 positive, nonsmokers, occult primary with pharyngeal sparing technique in patients who have undergone extensive TORS workup?

Is there a reliable way to distinguish a metastasis from a secondary primary tumor if the histology is the same?

For example, a patient with SCC of the H&N and has a lung mass that is SCC, would these be two separate primaries or metastasis? What is the best ...

Considering the surgical margins used in TORS, is it necessary to cover the entire tongue base with an elective dose in IMRT of cT1-3 HPV+ squamous cell carcinoma grossly involving one side of the base of tongue?

For instance, VMAT planning can sometimes deliver very low doses to the contralateral base of tongue. Do you worry about this? What is your approach?

Do you offer definitive radiotherapy for recurrent carcinoma in situ of oral cavity in a patient who is not a surgical candidate?

If so, what dose fractionation and field is recommended?

What cisplatin regimen do you prefer with adjuvant radiation in oropharyngeal SCC that is pT4N2 after surgery and bilateral neck dissection?

Is there data for weekly versus every 3 week cisplatin in this setting?

Would you offer adjuvant TKI to patients with locally recurrent multifocal adenoid cystic carcinoma?

For example, for a patient that has been through multiple disfiguring surgeries and radiation and wants to delay time to next resection.

How do you counsel patients receiving head and neck radiation regarding its impact on both existing and future dental work?

Please comment specifically on fillings, crowns, and implants.

Is there a threshold dose to the mandible above which you consider prophylactic HBO prior to dental extractions that are required after RT?

What are the indications for radiation after cord stripping for early-stage glottic cancers?

How do you advise your patients on toxicity?

What is your first line therapy for progressive symptomatic metastatic adenoid cystic carcinoma?

Do you start with TKIs or platinums?

Is there a maximum time delay in offering adjuvant radiation to patients with wound healing issues for sarcoma and skin cancer patients with aggressive histology and positive margins?

Sometimes wound healing can delay adjuvant radiotherapy by several months. For aggressive histology, such as high grade sarcomas or skin cancers with&...

For concurrent chemoradiation in head and neck cancers, how important is the timing of weekly radiosensitizing cisplatin early versus late in the week?

Specifically with reference to rural settings where the logistics of early in the week delivery may be more challenging.

What's your approach to adjuvant therapy for neuroendocrine (small cell) cancer of the parotid gland?

Patient had superficial parotidectomy, with negative margins. No nodes on imaging. Specifically, treat parotid bed alone? Add nodes if N0 on scanning?...

How do you manage persistent tumors at the primary and/or nodal site for p16+ tonsilar SCC after definitive chemo-RT?

How long do you allow for response before deeming it suspicious for residual disease? What work up (imaging, biopsy) do you recommend? How do you sa...

Do you use a custom wax tongue immobilizer for oral cavity radiotherapy?

If so, how do you address the Joint Commission's cleaning requirements? The Joint Commission recently inspected our hospital including the radiation o...

How do you manage patients with dementia who require but cannot tolerate an aquaplast mask for radiation therapy?

Benzodiazepines are not ideal in this population. Are there superior alternatives, perhaps antipsychotics, that are effective and superior?

Do you typically recommend re-resection for secretory carcinoma of the parotid with focal positive margins?

If re-resection would yield negative margins, is observation appropriate? Does the presence of focal PNI push you toward adjuvant RT (without re-resec...

How do you manage metal dental fillings/prosthetics and hot spot concerns for head/neck radiation?

Do you routinely employ dental wax? Does it depend on the material (titanum vs. other)? Do you take the extra time to replace metal with porcelain whe...

What is a safe and effective dose and fractionation for palliating head and neck cancer?

10 Answers available

Is it ever appropriate to treat just the ipsilateral oropharynx and neck for head and neck cancer of unknown primary?

For example, HPV+ SCC in a single level II node

How do you delineate target volumes for patients who receive induction chemotherapy prior to definitive chemoradiation for locally advanced head and neck cancers?

How do you account for the change in tumor volume? Do you use pre or post-chemo volume? Do you alter dose based on response?

How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

How do you manage in-field perineural recurrences in the skull base?

What anatomical sites would you electively cover to intermediate dose for an oropharyngeal primary with clear extension into the nasopharynx?

For what is clearly a oropharyngeal primary, with clear extension up the soft palate and into the nasopharyngeal lateral wall, should the intermediate...

How do you approach a SCC of unknown primary that is metastatic to a submental (level IA) lymph node?

p16 positive vs negative?

Would you omit radiation to the R0 tonsil tumor bed after TORS for p16+ tonsillar SCC when delivering adjuvant radiation to the neck due to + lymph nodes found intraoperatively?

Would you switch from weekly cetuximab to cisplatin during definitive chemoRT for locally advanced oropharyngeal SCC?

Patient initially was started on cetuximab due to renal insufficiency of unclear chronicity (uncontrolled hypertension) that significantly improved du...

0 Answers available

How do you approach the work up and surgery for H&N SCC of unknown primary?

Do you recommend for EUA/biopsies/tonsillectomies to look for primary as well as neck dissection (at the same time to save a trip to the OR), or attem...

Would you offer post-operative radiation to a patient with a parotid basal cell adenocarcinoma after a negative margin resection?

Do you always use platinum/5-FU as the chemo backbone with pembrolizumab for recurrent/metastatic H&N cancer?

Although platinum/5-FU was used in KEYNOTE-048, can an alternative like carbo/paclitaxel be given since it may be better tolerated?

How would you manage a local recurrence at the skull base after concurrent chemoRT for locally advanced nasopharyngeal carcinoma?

Given not surgical candidate and within 1 year of chemoRT (recurrence within RT field), would you repeat chemoRT, RT alone, or systemic therapy alone?...

When is the earliest you would consider starting radiation after total laryngectomy?

How often do women develop HPV associated oropharyngeal cancers?

Assuming the answer is quite low, the next question is why?

Do you check baseline or surveillance audiometry (if not overtly symptomatic) to screen for hearing loss in all patients getting cisplatin?

Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?

How do you approach post operative radiation therapy to someone with head and neck cancer who has high risk of local recurrence who also has scleroderma?

Is there any literature on the safety of giving radiation to patients with scleroderma in H&N setting?

For head and neck cancer patients who are already edentulous, do you have them leave dentures in for treatment (to avoid changes in jaw position)?

Do you favor tongue depressor instead? Does this change based on what primary you're targeting (i.e. base of tongue)?

Do you offer induction chemotherapy for patients with cT4N0 laryngeal cancer who decline surgery and are not candidates for high dose cisplatin-based concurrent RT?

NCCN suggests either concurrent chemoRT or induction chemotherapy in these patients.

How do you deal with worsening tinnitus in patients on concurrent chemoradiation with weekly cisplatin for head and neck cancer?

In light of recent data from ASCO 2019 and the NEJM, would you recommend induction chemotherapy or an adjuvant approach in combination with chemoradiation for locally advanced nasopharyngeal carcinoma?

Does your approach differ by EBV status?

How soon after ChemoRT for a head and neck cancer can you safely initiate esophageal dilation?

How do you manage early stage tonsil SCC treated by simple tonsillectomy alone?

Provided that staging PET/CT showed no residual disease or neck involvement, would you recommend completion surgery and neck dissection? Or do you vie...

For clinically node negative large squamous cell carcinomas of the scalp vertex, would you electively treat the nodes?

If so, which levels? Bilateral? What about parotids or submandibular gland?

Can over the counter mouth guards be used to reduce back scatter from dental fillings during head and neck radiation?

Custom devices with dentistry can be cost-prohibitive.

How would you treat a isolated, high grade neuroendocrine carcinoma of the neck with no obvious primary or systemic disease?

Would you recommend surgery, definitive chemoRT, or chemotherapy alone?

Do you recommend carotid ultrasound screening at some point post definitive H&N XRT?

Should this be part of the follow up?

Are there specific high riks features for which you would offer palliative adjuvant head and neck radiation in the setting of metastatic disease but without residual gross head/neck disease?

For patients with metastatic radioctive iodine refractory papillary thyroid carcinoma that is BRAF V600E mutant and rapidly progressive, would you consider dabrafenib/trametinib combo instead of lenvantinib or sorafenib first line?

Aggressive histology with tall cell variant papillary thyroid carcinoma that's progressed 2 months after RAI and while on TSH suppression, without tra...

Do you recommend prophylactic hyperbaric oxygen for patients who require tooth extraction after head and neck radiation?

What systemic therapy would you suggest for metastatic odontogenic clear cell carcinoma with no actionable mutations on NGS?

0 Answers available

What dose do you use for definitive treatment of squamous cell carcinoma of the cervical esophagus?

Let's re-open the debate!

What elective areas do you cover for a primary oropharynx SCC isolated to the pharyngeal wall?

This is an uncommon clinical scenario where textbooks suggest to cover the primary tumor and elective coverage of levels II-IV Do you cover any addit...

At what point would you no longer offer adjuvant radiation for adenoid cystic ca of the head and neck?

In a patient with indication for adjuvant radiation (ie. positive margins) after surgery without recurrence, when would you opt for observation only, ...

Would you offer adjuvant radiation therapy for high grade T1 nasal vestibule squamous cell carcinoma with negative margin (5mm) but positive focal perineural invasion?

What factors do you consider in offering adjuvant radiation to the primary and/or elective nodes in nasal SCC? What volumes would you cover?

Should upfront neck dissection in head and neck squamous cell carcinoma obviate the need for chemo in a T1N2 oropharyngeal cancer with no ECE?

Some ENTs advocate for a neck dissection as a way to avoid chemotherapy if there is a high chance there is no ECE. This is without removing the primar...

When do you consider upfront surgery for locally advanced (T4) sinonasal CA?

Would you proceed with induction chemotherapy (eg TPF or cis/gem) to downstage or neoadjuvant chemoRT? Would your approach be different if there is or...

How would you approach a locally advanced, radioiodine naive papillary thyroid carcinoma not amenable to a non-morbid surgery?

Have you seen RAI or lenvatinib be efficacious for locally advanced disease — allowing for better surgical outcomes? Do you utilize EBRT?

How long after surgery would you no longer offer adjuvant postoperative treatment for head and neck cancer when a patient (with multiple adverse features that needs adjuvant treatment) keeps postponing the start of radiation?

Is there a time cutoff where there is no longer a benefit to adjuvant radiation and you recommend reserving radiation only in case of recurrence? Sim...

Do you routinely use bolus for treatment of early stage glottic cancer?

How do you approach a case of nasopharyngeal adenoid cystic carcinoma with neck node unilaeral involvement?

Do you use same contour guidelines of nasopharyngeal cancer? What levels would you cover on the involved neck side? When would you electively cover t...

What RT dose do you recommend for carcinoma in situ of the glottic larynx?

What is your approach to re-irradiation of the brachial plexus?

For example, when a patient has received 60-70 Gy with concurrent chemotherapy, do you consider dmax, BED, and interval between repeat courses of trea...

How long after a tracheostomy would you wait before initiating RT?

In fully resected oral scc pts with high risk factors that does not cross midline, would you radiate the contralateral neck if it is pN0?

Does the full dissection with no LN mets allow sparing PORT to the contralateral side?

How would you manage contralateral neck recurrence <6 mos. following resection and adjuvant CCRT for node positive tongue cancer?

If neck dissection was done, do you offer adjuvant chemo and/or XRT?

How do you manage soft tissue necrosis in a patient who underwent TORS followed by RT?

When using Quad Shot regimen for palliation of unresectable head and neck cancers, would you treat concurrently with chemotherapy?

If not, how long would you wait between chemotherapy cycles to give treatment?

Can a nonbulky, T1-2 supraglottic larynx cancer near the vocal cords be treated like a glottic tumor?

What field size and dose/fractionation would you use? Would you treat lymph nodes?

Are there any specific high risk features or situations for which you would offer adjuvant radiation to a newly diagnosed benign pleomorphic adenomas following resection?

Most of the literature experiences seem to focus only in the recurrent settings.

What is your approach for a primary tracheal squamous cell carcinoma?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Would you electively cover any nerves for adenoid cystic carcinoma of the tonsil with positive PNI on pathology?

How would you manage a spindle cell carcinoma of the Glottic (T1-T2N0) compartment and what fractionation would you use?

Is there a role for an altered fractionation regimen as an organ-preservation approach? This pathological variant is uncommon and the older literatur...

How to you account for motion when contouring head and neck primaries in more mobile areas such as base of tongue and larynx?

Do you routinely adjust margins to account for internal target motion?

How do you treat intact SCC of the subglottic larynx?

NCCN Guidelines do not address this rare form of H&N cancer. What dose/fractionation would you use for definitive radiation? Is elective nodal co...

How old was the most elderly patient you have successfully treated with definitive radiation or chemoradiation for advanced oropharyngeal cancer?

Is there an age in which you would not offer definitive treatment? How do systemic therapy options, dose, and field sizes change with age of the pati...

What dose and fractionation do you use for definitive radiation for SCC in situ of glottic larynx?

Per NCCN, treatment options include endoscopic resection (preferred) or definitive RT. The recommended dose is 60.75 Gy in 27 fractions for in-situ vs...

How do you approach your choice of systemic therapy for relapsed/metastatic H&N cancer (failed definitive concurrent chemoRT) not amenable to further locoregional therapies?

Do you have a time threshold for re-challenge with platinum? Of note, Checkmate 141 defined platinum refractory as relapse within 6 months of pl...

How would you treat a limited stage small cell carcinoma of the larynx?

What dose and fractionation would you use. What is your target volume?

How do you time same-day chemotherapy and radiation for patients undergoing concurrent chemoRT?

For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be giv...

If a stage I laryngeal cancer completely responds to FU-based chemotherapy (given for another malignancy) would you consider observation?

Would you consider RT to LNs in a gr 2-3 adenocarcinoma of the lacrimal gland if there are high risk features?

If so, what high risk features would influence your decision? Would + margins, PNI, LVSI etc be reason to treat LN? If you would treat lymph nod...

How would you treat esthesioneuroblastoma resected with focal microscopically positive margins in difficult to resect skull base regions?

Acknowledging the mixed data, would you feel comfortable that radiation could compensate for the R1 margin? Would you push the surgeons to re-resect?

How do you manage dry mouth after head and neck RT?

Please share your tips on dealing with short and long term xerostomia.

How do you approach the treatment of patients with unresectable paransasal sinus cancers in close proximity to the critical structures of the base of skull?

How do you balance the goal of effective definitive treatment while minimizing the risk of injury to critical structures?

How do you approach dosing for post-op HNSCC nodal regions with ECE?

Do you modify your dose based on p16 or extent of ECE (e.g. microscopic vs macroscopic)?

How do you manage a patient who develops Lhermitte's sign?

In what scenario, if any, would you treat a unilateral neck (vs. bilateral neck) for post-operative oral cavity (in historically midline structures such as oral tongue, FOM etc) SCC patients?

Do you prefer covering bilateral neck in all cases or do you make exceptions? There appears to be conflicting opinions in the literature: https://ww...

What is your preferred radiation sensitizing regimen for cisplatin-ineligible patients with locally advanced unresectable p16+ tonsil SCCa?

In what situation, if any, would you combine immunotherapy concurrently with radiation for patients with head and neck cancer?

What about in the metastatic and non-metastatic setting, specifically? Any additional treatment (dose/fractionation) or toxicity considerations for th...

What is your treatment approach for p16+ oropharyngeal carcinoma with one positive node on neck dissection?

What is your recommended surveillance imaging routine for a patient with an esthesioneuroblastoma following adjuvant radiation?

How would you manage recurrent laryngeal cancer after previous larynx xrt if surgical salvage not an option?

Surgical salvage is indicated but not possible in all cases due to comorbidities or patient preference. Would you re-irradiate and how? Would you co...

How stringent or flexible are you with concurrent chemotherapy and radiation starting on the same day in the definitive CRT setting for HN patients?

Do you ever start radiation +/- 24-48 hrs from C1D1 for chemotherapy due to logistical barriers? Do you prefer chemotherapy to start at beginning of ...

Can you spare radiation to the neck on a lateralized supraglottic cancer with cN0 neck clinically and neg nodes on PET?

How do you prevent/treat nasal synechiae after radiation for SCC of nasal vestibule?

Do you treat facial and peri-parotid nodes in locally advanced nasal cavity/nasal vestibule cancer?

How do you manage small oropharyngeal cancers with N1 or N2 disease?

Is concurrent chemotherapy necessary for these patients?

For postoperative radiation for oral cavity cancer, should the entire surgical bed including grafts and plates (eg reconstructed mandible) receive the full 60 Gy?

The surgical bed created by reconstruction is often quite larger than the surgical bed from tumor resection and neck dissection.

When would you cover the pre- and/or post-auricular nodal basins electively in the post-op setting for tumor involving the parotid gland?

Does the histology (primary salivary gland vs metastatic squamous from a skin primary) affect your decision making? Any other factors that influence ...

How do you approach elective cranial nerve target volumes for head and neck cancers to account for potential retrograde or anterograde spread along cranial nerves?

Are there any general principles you apply for how far to track along a given nerve in either direction?

How would you manage a small to medium sized but unresectable nodal recurrence within the original treatment volume for a head and neck squamous cell carcinoma?

If you would re-irradiate, what dose/fractionation would you use? What systemic therapy would you use concurrent with treatment, if any?

Do you attempt to spare the submandibular glands in head and neck IMRT?

If so, what dose constraints do you use?

How would you manage papillary variant squamous cell carcinoma of the oropharynx?

Does papillary histology influence your decisions regarding surgery, chemo, radiation dose or nodal coverage?

When would you use concurrent cetuximab with radiation for a patient with H&N cancer who is not a good candidate for concurrent chemotherapy?

Routinely? Only with oropharyngeal cancer etc.? Given that low expression of EGFR subset did better, do you believe there is a true benefit in cetuxim...

What is the best test to determine HPV status for SCC?

Is it preferable to do HPV RNA FISH testing or p16 immunostain testing to determine HPV status? Is one test more accurate than the other? &...

What is your approach for treating oligometastatic head and neck cancer in patients with a good performance status?

Do you routinely offer definitive head and neck chemoradiation and aggressive local therapies to the oligometastatic sites?

What is your criteria for a prophylactic PEG tube in patients initiating head and neck radiotherapy?

What dose fractionation schedule do you use to treat head and neck cancer in a patient with Fanconi's Anemia?

Patient's with Fanconi's anemia can have severe/fatal toxicity with chemotherapy and radiation but unfortunately can also present with aggressive head...

Should I avoid prescribing lidocaine-containing magic mouthwash to head and neck cancer patients?

Because patients with locally advanced H&N cancers are at increased risk for aspiration, and radiation may increase that risk, some clinicians rem...

How would you approach distant oligometastatic HPV positive oropharyngeal cancer previously treated with definitive local therapy?

Would you offer locoregional control alone, locoregional with adjuvant therapy, or active surveillance?

What is the longest treatment break you would allow during definitive HN RT +/- chemo?

At what point would you consider the treatment break to be too long for curative treatment?

Would you offer radiation therapy to a NF-1 patient with a painful and unresectable neurofibroma of the head and neck?

If so, what dose would you use?

Would you alter your treatment plan of the neck for oropharynx cancer after an excisional biopsy/violation of the neck?

Do you have concern for aberrant lymphatic drainage? Do you cover more generously (ie. add IB/V on the contralateral cN0 neck etc.)?

How would you treat recurrent parotid gland carcinoma with unresectable, metastatic disease?

What is the best way to manage severe claustrophobia and anxiety for Thermoplastic masks?

What are your criteria for inclusion of the retropharyngeal LN in node negative H&N cancer patients?

Aside from Other nasopharyngeal ca patients and those with cancers of the posterior pharyngeal wall, how do you contend with risks of dysphagia w...

What types of supportive care do you offer patients undergoing definitive therapy for their head and neck cancer?

How do you prevent and treat lymphedema following head and neck XRT?

What volume would you cover for HPV-positive SCC of level IB node with ECE?

Under what circumstances would you consider reirradiation for a patient with recurrent previously irradiated early stage laryngeal cancer now s/p salvage laryngectomy?

Would you treat all cases or only select risk factors (T4, N+/ECE, margin+, LVI etc.)? What would you treat? Would a negative neck diseect...

How would you treat a patient with head and neck squamous cell carcinoma and adverse features with borderline renal function in the adjuvant setting?

Which of the systemic options would you give concurrently with radiation therapy in the adjuvant setting? According to NCCN guidelines, high dose...

Do you alter definitive treatment recommendations for oropharynx p16+ cancers based on the new staging?

The new AJCC staging factors in HPV status and can drastically alter a patients overall stage group, hence dramatically change definitive treatment re...

Aside from ECE or positive surgical margins, when (if ever) would you offer post-operative chemoradiation in patients with squamous cell cancer of the head and neck?

The NCCN guidelines give the option of "consider systemic tx/RT" for "other factors," what do you consider as other factors? For example: close margin...

How would you treat a synchronous anal and oropharyngeal squamous cell carcinoma?

If the oropharyngeal cancer is operable (ex T1N1), would would your preference be upfront surgery? Would you use chemoradiation therapy to bo...

Would you ever NOT recommend adding concurrent chemotherapy to adjuvant radiation in +ECE oropharynx SCC patients who can tolerate it?

In the context of the new staging systems and possible differences of HPV mediated vs smoking mediated oropharynx SCC, would you ever not recommend co...

When do you use amifostine in head and neck cancers?

What dose constraints do you use for pituitary in a young woman with completely resected esthesioneuroblastoma?

Is ENI necessary for postoperative treatment of clinically N0 adenoid cystic carcinoma of the head and neck?

How would you manage a patient with synchronous locally advanced H&N (p16+) and locally advanced rectal adenocarcinoma?

If treating the H&N first, would you anticipate some effect of chemo on the rectal cancer? Would you include 5FU in the H&N chemo for be...

What is your preferred dose-fractionation regimen for cT1-T2N0 oropharynx treated with radiation alone?

Is conventional fractionation acceptable, or would you use altered fractionation (DAHANCA, SIB, BID etc.)?

How would you treat epithelial-myoepithelial carcinoma of the parotid following resection with clear but close surgical margins?

The reports I've read indicate a fairly high rate of local recurrence and wanted to see if any can give guidance on this fairly rare tumor.

Would you add elective nodal radiation for high-grade myoepithelial carcinoma of the hard palate in addition to adjuvant radiation of the post-operative bed?

How, if at all, has the new DAHANCA H&N contouring guidelines changed how you delineate low dose CTV (CTV-P2) for head and neck cancer primaries?

Should any additional anatomical areas be intentionally included in CTV-P2 if it goes beyond the "5+5" expansion? The text (found here:https://www.ncb...

What criteria do you use for choosing (or, pointedly, not choosing) parotid sparing with IMRT in patients with bilateral neck nodal disease from a mucosal head and neck cancer?

For an unknown primary manifested in a left supraclavicular node, what area would you treat with radiation therapy?

What are the indications for adjuvant radiation for a resected acinic carcinoma of the parotid?

Is close margins <=1mm alone enough to warrant adjuvant radiation? What about other factors such as p-Staging, PNI, LVI etc.?

Do you routinely screen for pituitary dysfunction after radiation therapy for nasopharyngeal cancer?

Studies have shown increased rate of endocrine dysfunction in these patients: https://www.ncbi.nlm.nih.gov/pubmed/26011172 https://www.ncbi.nlm.nih....

How do you manage dysgeusia from head and neck radiation?

Does anything work?

How do you manage HPV positive squamous cell carcinoma in situ of the oropharynx?

How do you approach a patient with locally advanced head and neck cancer requiring chemoradiation that needs extensive dental work from an oral surgeon, but because of insurance and social issues cannot feasibly get the teeth removed?

Do you still treat with definitive radiation and counsel about the risk of osteoradionecrosis? Or consider a palliative approach?

How do you approach treatment of a locally advanced primary tongue SCC lesion spanning oral cavity and base of tongue?

In the case where patient history and pathology markers are uninformative to distinguish oral cavity vs oropharynx, do you tend to favor up front surg...

How would you approach a patient with simultaneously diagnosed stage IVA SCC of the head and neck and limited stage small cell lung cancer (neither is symptomatic)?

Would you recommend chemo alone first? Would you treat with definite chemo-RT to the lung then the head/neck or vice versa? How would this chan...

Would you recommend concurrent chemotherapy for a T1N1 oropharynx cancer if the patient underwent excisional biopsy of the node and was found to have ECE?

How would you use the information regarding extent of ECE? What if the patient was HPV negative? What is the impact of systemic therapy on...

Do you have indications for adjuvant radiation in H&N cancers (oropharynx, oral cavity etc.) other than listed in the NCCN guidelines (ECE, positive margins, pT3/4, N2/3 or Lv IV/V, PNI, LVSI)?

For example, do you ever offer adjuvant RT for pT2N1 SCC of BOT without any of the above adverse features?

In what situation would you cover the scar of a temporary tracheostomy post-operatively for oral cavity cancer?

There have been some retrospective studies in the literature describing recurrences in the the site of a temporary trachoestomy for head and neck mali...

Would you treat a T2N0 high grade neuroendocrine carcinoma of the nasal cavity after a R1 resection?

Would you prophylactically treat LNs as well? Is so, what lymph node regions would you treat if it arose from the sphenoethmoidal recess?

How do you treat locally recurrent papillary thyroid carcinoma following multiple surgeries/RAI?

When would you use EBRT? What dose should be used and what extent of nodal treatment should be included? Is there a tracheal dose constraint?

What is your surveillance strategy for locally advanced HPV+ oropharynx cancer after PET CR?

Is any further imaging warranted or is clinical surveillance sufficient? Do you recommend a repeat PET at a year (PMID: 28854069) or beyond...

Do you routinely use imaging (US, whole body iodine scans etc.) to follow papillary or follicular thyroid cancer after thyroidectomy and RAI therapy?

Is there any evidence that this improves outcomes over a more simple and cost effective follow up of careful physical examination and checking a perio...

What features would make you consider covering elective nodes in a locally advanced, node negative paranasal sinus SCC?

Is there strong evidence to guide this decision?

How do you treat recurrent tracheal carcinoma?

Any role for endotracheal brachytherapy? If so, how long after laser treatment would it be safe to use endotracheal brachytherapy and at what dose?

Does p16 status (HPV) influence your decision on whether to offer adjuvant chemoradiation or radiation in node positive H&N cancers?

In the new AJCC 8th edition, p16+ downstages many patients from what used to be stage IV. Should the adjuvant therapy for these patients be de-escalat...

How do you treat elective neck regions in a patient with a second primary HN cancer and prior neck dissection and radiation?

How do you approach treatment volumes and dosing around post-operative neck dissection scars in patients with head and neck SCCs?

Do you always take scar to full dose or do you use specific criteria (e.g. ECE or LVI) to determine dosing and coverage? Do you routinely bolus with I...

When is the coverage of tracheostomy site required for Head & Neck cancer radiation therapy and to what dose?

How does it vary based on disease site, lymphatics involvement, emergent vs. non-emergent trach etc.?

How do you treat a parotid Warthin's tumor in a medically inoperable patient?

Is there any experience with radiation therapy?

What is your palliative radiation approach to larger volume locoregional head and neck SCC recurrences?

How does your dose/fractionation vary for patients with and without prior radiation? How do you decide on the treatment volume? In particular, how do...

What dose would you use for multifocal, recurrent, subtotally resected pleomorphic adenoma of the left neck salivary glands?

A retrospective review of the use of adjuvant radiation in the recurrent setting for pleomorphic adenoma of the parotid gland reported a 20 year actua...

Do you leave the tracheostomy tube in place or take it out during each head and neck cancer radiation treatment?

If you leave it in, do you still use bolus?

In the setting of head and neck cancer, if the pathology report shows extranodal extension (ECE), but the location of the node is uncertain, how do you define your boost volume?

Would you give post operative radiation for a pT1N0 parotid low grade mucoepidermoid carcinoma with positive margin on the facial nerve to an adolescent?

Would the risk of secondary malignancy affect the decision?

How would you utilize adjuvant radiation therapy in a patient with a cutaneous spindle cell neoplasm of the scalp metastatic to the parotid gland?

What dose-fractionation schedule and treatment volumes would you utilize for adjuvant radiation therapy status-post total parotidectomy with negative ...

What factors would make you consider adding adjuvant radiation to the neck of H&N cancer after a negative dissection (pN0)?

For pN2b disease after bilateral neck dissection, is PORT to the negative side of the neck indicated?

What is the best fractionation for head and neck patients who cannot receive systemic therapy due to KPS or medical comorbidities?

Do you have a KPS or other cutoffs that would deter you from using accelerated fractionation due to concern for toxicity?

What factors would push you to consider using IMRT vs opposed lateral fields for a T2N0 glottic SCC?

Would having supraglottic extension lead you to use IMRT?

How do you simulate a patient with a large beard who needs a thermoplastic mask?

Would you insist that they shave or cut the beard? Is there a way to make the simulation reproducible without removing the beard?

Do you ever use altered fractionation in the postoperative setting for patients with head and neck SCC?

Would you consider altered fractionation in a postop patient who has ECE or positive margins but is refusing chemotherapy?

What PTV dose heterogeneity do you accept for head and neck radiation plans?

Do you have a max dose constraint for PTV? Volume receiving dose higher than prescription? There seems to be variation among RTOG protocols from max d...

Would you treat an unresectable papillary thyroid carcinoma metastasis to the nasopharynx with skull base and perineurial invasion with radioactive iodine, radiation therapy, or chemo-radiation?

How do you manage a head and neck cancer patient with the presence of high grade dysplasia at a margin?

Do you consider this a positive margin? Would you boost this area to a higher dose? Would you recommend concurrent chemotherapy in the abs...

Do you prefer rhTSH for TSH stimulation instead of thyroid hormone withdrawal when treating patients with radioactive iodine for papillary thyroid carcinoma?

If not, what is your thyroid hormone withdrawal protocol? If so, would you still treat a patient with possibly metastatic disease?

What normal tissue constraints do you use when treating a palliative head and neck patient with the Quad Shot?

The Phase II Austrialian study mentioned here only specified a spinal cord constraint of 28Gy in 8 fractions. Should other normal tissue constrai...

In patients with newly diagnosed cervical esophageal cancer with limited metastatic disease, do you treat the primary with chemoradiation?

How do you manage dental care, oral hygiene, and nutrition in patients with trismus?

Should lymph nodes be treated with postop RT of undifferentiated pleomorphic sarcoma of the head and neck?

Specifically, the cheek? If so, which nodes should be treated and to what dose?

What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?

When would you recommend definitive radiation or surgery + PORT for a resectable skin cancer metastatic to the parotid?

In which patients do you offer adjuvant radiation for porocarcinoma?

If a patient has undergone wide local excision with residual disease, but negative margins, is it safe to observe? If adjuvant treatment is indicated,...

What is the best treatment for a Head and Neck cancer in a patient with Parkinson's disease with nuerostimulators located in the clavicular region?

Aside from relocating the generators, does anyone have any experience or knowledge about tolerance of the devices?

How to you manage radiation brachial plexopathy in head & neck patients?

Have we established standard doses for radiation therapy for H&N cancers?

Are there dose-response studies establishing 70Gy is the optimal dose for gross tumor control, or is it simply thought to be the maximally tolerated d...

Does p16 status influence your decision when choosing between surgery and definitive chemo-RT for head and neck patients?

Is there data to support that surgery works better than chemo-RT in p16 negative patients?

Do you treat the contralateral RP nodes up to the base of skull in a node-negative neck if the primary tumor involves any hypopharyngeal subsite?

For example, a larynx primary with direct extension to medial pyriform sinus?

How do you manage patients who need radiation for synchronous locally advanced head and neck cancer and locally advanced breast cancer?

Would you recommend a mastectomy for her breast cancer in attempts to avoid RT? If the patient undergoes a lumpectomy or needs PMRT, would you a...

How do you apply hyperfractionated RT in the dose painting IMRT era in head and neck cancers?

Especially in patients who are not candidates for chemotherapy, what dose and fractionation should be applied given the fact that hyperfractionation w...

Do you treat elective cervical lymph nodes for SNUC (sinonasal undifferentiated carcinoma) of the ethmoid sinus?

For an N0 patient with locally advanced (T4a) SNUC of the ethmoid sinus, would you include elective cervical lymph node irradiation? If so, what...

What do you recommend if you find persistent lymphadenopathy during CT simulation for adjuvant head/neck radiation therapy?

How does your department manage scheduling surrounding holidays?

If a holiday falls during the week do you treat all patients, a select subset of patients (i.e. cervix, head and neck) or give everyone the ...

While we await the completion of RTOG 1008, what instances do you offer chemotherapy for salivary gland tumors?

How do you manage radiation induced serous otitis media?

Do you ever hold treatment? Would you consider any of the following: decongestants, anti-inflammatories (e.g. steroid burst), antibiotics, or myringot...

What is your preferred first-line regimen for metastatic head and neck cancer?

Do you typically use 5-FU/cisplatin/cetuximab, or do you prefer other options?

What do your treatment volumes include when treating a resected mucoepidermoid carcinoma of the parotid gland with close, but negative, margins where recurrence would require sacrifice of branches of the facial nerve?

Would you include the surgical scar? If so, what margin around the scar would suffice?

How do you approach teeth extractions for head and neck cancer patients getting radiation?

We have seen a lot of patients referred to oral surgeons who insist all their teeth are in poor shape, leaving these patients edentulous. What do you...

How do you manage excessive or difficult to control secretions in patients who have received chemoradiation for head and neck cancer?

Any up to date interventions? Which expectorants have been effective?

What criteria do you use for replanning with a new CT simulation for patients being treated definitively for head and neck cancer?

Do you have any rules of thumb regarding amount of weight loss, a percentage change in the size of the primary/node, or the fit of the mask?

When does perineural invasion for a squamous cell carcinoma of the skin of the head and neck merit adjuvant radiotherapy?

Following Mohs surgery and in the absence of other high risk features, do you offer RT for any PNI? A single nerve < 0.1 mm? A single ne...

Is there a time frame between surgery and radiation, after which, the benefit of adjuvant radiation is lost and no longer indicated for head and neck cancers?

If so, is the time different based on intermediate (T4, N+, LVI etc.) vs high (ECE, +Margin etc.) risk indications for adjuvant RT?"

Do you transfuse anemic head and neck cancer patients undergoing chemoradiation?

If so, when? Although anemia is associated with worse local control in HN cancer, I don't know of any data that shows that blood transfusions can help...

In laryngeal cancer (assuming no pharyngeal extension) with level II/III involvement, should RPs and level IB on the involved side be covered?

What about Lv V and VI?

How common is hypothyroidism in postradiation head and neck cancer patients?

Do you treat patients who are clinically hypothyroid but biochemically euthyroid?

How do you sequence systemic therapies for recurrent/metastatic head/neck cancer following the recent approval of pembrolizumab?

Do HPV and/or PD-L1 status influence your decision making?

For treatments using thermoplastic mask immobilaztion, when supplemental bolus is needed, what is your method for ensuring reproducibility of set-up and bolus effect efficacy?

Does it make a difference if you place the bolus above or below the mask?

What is the role of up-front neck dissection in locally advanced head and neck squamous cell carcinoma?

Specifically, what arguments can be made for or against upfront neck dissection in patients who present with necrotic neck nodes? How would the ...

Does the better prognosis associated with p16+ H&N cancers relate only to patients who are treated with RT +/- chemo?

Does the better prognosis associated with p16+ H&N cancers relate only to patients who are treated with RT +/- chemo? Or do they do better in...

How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?

If a patient had a recurrence that was pathologically proven despite negative idodine scans, what imaging scans would you follow up with for surveilla...

When should post-op RT be offered in patients with recurrent papillary thyroid carcinoma that no longer takes up iodine?

Should post-op RT be offered to patients after a recurrence in the cervical lymph nodes after a neck dissection?

What role does external beam radiotherapy play in the treatment of well differentiated papillary thyroid cancer when a total thyroidectomy and lymph node dissection cannot be performed?

In the case of a partial resection with focal perineural invasion, but no lymphadenectomy due to severe fibrosis from prior radio-ablation for hyperth...

What do you consider negative or close margins for tonsillar cancers?

Does your postop dose change or use of chemo change if you have close margins?

When do you consider boosting the the tracheostomy site in post operative head and neck cancer patients?

What dose would you boost to in each situation?

When do you employ post-op external beam radiotherapy in papillary thyroid carcinoma?

Is RAI sufficient in cases of +margin but negative post-op iodine scan? In cases where there was no pre-op radioactive iodine scan to ensure iodi...

How do you deal with the brachial plexus in head and neck cancer radiation (ie suprglottic larynx) when there is a positive node near the plexus or when you have an involved nodal level that you want to take to a higher dose?

What are the contraints you look for?

Is post-operative radiotherapy indicated in HPV associated, < 10 pack year smoking, low volume (i.e. T1N1) squamous cell carcinomas of the head and neck when the only adverse risk feature present on pathology is LVSI?

In this circumstance is their any evidence that indicates a locoregional control benefit to PORT?

What dose would you give for unresectable anaplastic thyroid carcinoma?

Is there a hypofractionated dose regimen that would be suitable for palliation prior to the patient going to hospice?

Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?

If so, what is your treatment volume?

When is post-op radiation not necessary for completely resected ipsilateral neck node recurrence in a previously UNirradiated neck?

For example: Initial primary of early stage completely resected oral cavity or oral tongue cancer with no adverse features and therefore did not get r...

What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...

When performing IMRT treatment planning for head and neck cancer, how do you instruct your dosimetrists to manage the optimization process for targets that are very close to the skin surface (or with PTVs that extend into air), yet the skin itself is not at risk?

For elective target volumes it makes sense in most cases to pull in the PTV 3-5mm from the skin for planning, but for gross disease close to the skin ...

Would you offer adjuvant radiotherapy to a small low grade T1 adenoid cystic carcinoma of the minor salivary gland that was completely resected?

After a wide excision for a <3mm lesion, flap reconstruction and selective neck dissection and no initial PNI, residual tumor, or positive ymph nod...

Do you recommend altered fractionation when using cetuximab with head and neck RT?

Since the Bonner trial only found a benefit to the combination of cetuximab with the concomitant boost arm, do you routinely recommend this fractionat...

For post-op H&N cancers, do you get CT neck with contrast prior to sim?

If so, when is the right time to obtain this? Are there situations when you recommend postop MRI ( for example, for patients with a large reconstructi...

What is your advice to patients who ask if dental X-rays correlate with oral/oropharyngeal cancer?

In post-op RT for head and neck cancer with a close or positive margin, is there data suggesting that 66 Gy at 2 Gy per fraction provides better local control than 63 Gy at 1.8 Gy per fraction?

Can the elective target volume in nasopharyngeal cancer, as specified in RTOG 0615, be reduced if OARs do not meet constraints?

Conversely, should OARs be kept within contraints if it requires dose compromise on these high risk CTV structures?

How do you effectively spare the medial RP nodes and superior constrictors when you contour the bilateral RP nodes and place a 3-5 mm CTV to PTV expansion?

Even if there is a gap, it is dosimetrically hard to spare that little strip.

What is the optimal dose and fractionation of RT for a T2N0 laryngeal SCC?

Particularly the old T2b with sluggish cords and rather diffuse involvement? The data is mixed with regard to hyper- fractionation, vs. hypo-frac...

For a pathologic Stage I squamous cell carcinoma of the oral tongue with negative margins and adequate neck dissection, is perineural or lymphovascuar invasion alone an indication for adjuvant radiotherapy?

What dose and volume would you use?

In patients who are HPV postive, and non-smokers who have a complete PET response to induction TPF at the primary site, would you still treat the primary site to full dose?

Do you treat the enlarged PET negative nodes to the high risk dose as well?

In a patient with history of early stage oral cavity cancer and a new ipsilateral neck failure, would you treat the initial site of disease?

In a patient with recurrent SCC in the neck s/p ***remote*** partial glossectomy (R0, 6 months ago), who is now s/p neck dissection for gross disease ...

What factors do you typically consider when deciding whether to include retropharyngeal lymph nodes within your treatment volumes for squamous cell carcinoma of the oral cavity or oropharynx?

What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?

After a nerve sparing parotidectomy, would you offer postoperative radiotherapy? If so, what volume and dose? Would it change your management if the p...

For cutaneous SCC of the cheek with microscopic PNI, which nodal levels, if any, do you prophylactically treat?

Do you prophylactically treat the entire parotid gland as well?

How do you manage parathyroid carcinomas with positive microscopic margins?

It seems that postoperative RT is indicated to help improve local control (based on small series from MD Anderson and Mayo Clinic). What areas s...

For patients with laryngeal cancer about to start chemoRT who have a narrow airway on imaging but are asymptomatic without any stridor or shortness of breath, do you take any precautions to prevent airway obstruction secondary to radiation-induced edema?

Do you pre-medicate with steroids?

To what dose do you treat enlarged, but PET negative lymph nodes in laryngeal SCC?

For a T3N0 SCC of the larynx with PET/CT showing negative cervical nodes, but with CT neck showing a 1.5cm level II cervical node, to what dose to you...

Is there data to suggest that definitive chemoradiation to 70Gy vs. postoperative chemoradiation to 60 or 66Gy has any different clinically significant effects on long term swallowing function and other side effects of H&N cancer treatment?

Our ENT surgeons often tell patients with evidence of matted nodes on imaging that their swallowing function will be much worse after 70Gy as compared...

Should cN0 oral cavity cancers that are completely resected but have indications for RT ever receive elective nodal RT?

Do the level II lymph nodes need to be covered for T2 SCC of the retormolar trigone if it is completely resected but has close margins?

What is your approach for a locally advanced (stage IVA secondary to N2 disease in the neck), HPV-negative, squamous cell carcinoma of the base of tongue in a patient without significant comorbidities?

Definitive chemoradiation vs. surgery followed by adjuvant radiation/chemoradiation?

When do you spare constrictors in head and neck treatment planning?

In contouring base of tongue, tonsil, larynx and other H+N tumors, the CTV and PTV will frequently encroach on the posterior pharyngeal wall. I'd appr...

What is the role in your clinic for chest imaging in head and neck cancer patients who are free of local disease 1+ years after treatment?

Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?

Is there a benefit to IMRT when we treat to relatively low doses (as compared to squamous cell cancers of the head and neck)?

How many PTVs and what doses do you utilize for a cT3N0M0 squamous cell carcinoma of the larynx receiving definitive concurrent chemoradiation?

Additionally, what lymph node levels do you typically treat?

How do you treat locally advanced medullary thyroid cancer with postoperative RT?

What dose and fractionation is appropriate for medullary thyroid carcinoma with extrathyroid extension, bilateral cervical lymph node levels 2-5 with ...

Do you treat neck nodes electively in transglottic/bulky T2N0 laryngeal cancers?

For example, for a tumor arising from the true cord and extending superiorly to false cord and inferiorly to subglottis with mobile vocal cords?

With a head and neck squamous cell of of unknown primary, do you typically treat the larynx?

Do you ever treat the contralateral neck for high grade mucoepidermoid salivary gland carcinomas?

For example, if there is extensive ipsilateral lymph node involvement and extracapsular extension for a submandibular gland tumor?

What criteria do you use for induction chemotherapy in advanced head and neck cancers?

Even though we do not have the best data on the use of induction chemotherapy, what are current practices? Is your practice different between HPV+ an...

Do you use altered fractionation in patients with locally advanced head and neck cancers who are not candidates for chemotherapy?