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?  

I treat the cancer to full dose. If the patient is suitable for a neck dissection you could possibly give 60 Gy and plan to add a neck dissection. However, if treating gross disease  or positive margins, go to 70 Gy.

I agree with @William M. Mendenhall's comments. In patients with a neck dissection, we will stop around 60 Gy. In patients without neck dissection we have gone to higher doses using conventional fractionation of 180 to 200 cGy per day without any injury. Our Results on 68 patients with a minimum fol...