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Head and Neck Cancers • Radiation Oncology
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 chemotherapy?
Aside from seeing an ophthalmologist early (e.g. at the start of therapy), using appropriate IMRT, and treating with the eyes open, are there specific approaches you would take to minimizing keratitis?
One can live without sight in one eye, but what limits would you impose on that approach?
Answer from: Radiation Oncologist at Community Practice
My personal approach is to always recommend induction systemic therapy for T4b unresectable disease with orbital invasion. If it is at all resectable (T4a), I agree with offering curative surgery (including enucleation) upfront or induction if that is a surgeon preference, then post-op chemoRT or RT...
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Answer from: Radiation Oncologist at Academic Institution
In locally advanced head neck tumors, I generally counsel a higher than normal risk of vision loss in one eye and slightly higher blindness risk. I don't think optic nerve tolerance is solely based on maximum dose and so I routinely take the an optic nerve to 70 Gy. Preserving the eye itself is...
Comments
Radiation Oncologist at UTMB
Agree with above—assuming curative treatment...
Agree with above—assuming curative treatment...