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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? This would be with the understanding that a positional shift may underdose this area slightly, which may or may not contain residual disease given the post-op setting.
Answer from: Radiation Oncologist at Academic Institution
This question has been examined by Allen Chen et al. if I recall. (PMID 29904734) In their study, patients (n=305) were treated either with an ipsilateral parotid sparing IMRT technique vs one that prioritized PTV coverage. 49% of their patients were post-op.For ipsilateral parotid sparing pati...
Answer from: Radiation Oncologist at Community Practice
I would only do this if it were a low-risk PTV where the risk of nodal spread is very low because of what we know about disease spread and biology. For example, high level II contralateral nodal PTV for a well lateralized T1N1 oral cavity cancer without bulky ipsilateral nodes.
It's great to ...
I agree with @Avraham Eisbruch. Although an early ...