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 are barely visible. Should large volumes of the bilateral neck still get 70 Gy? What dose do you use in level IV near the brachial plexus?

Answer from: Radiation Oncologist at Academic Institution

I agree with Dr. @Mendenhall. I do not change my volumes based on response to induction chemotherapy. It may be difficult to outline the nodal volume if there is complete response to chemo but I have not really encountered that scenario so far. I use the initial PET and diagnostic CT scans fused wit...

Answer from: Radiation Oncologist at Academic Institution

Comments

Radiation Oncologist at Munson Medical Center
I’ve still followed contouring guidelines fr...

Answer from: Radiation Oncologist at Community Practice

No volume reduction - i.e. include all of pre induction chemo volume. But may reduce dose to appx 60 Gy (like intermediate risk) to that pre chemo volume, while treating any gross residual dz to 70 Gy. We usually don't go above 66 Gy to the plexus and 66 Gy is indeed a tumoricidal dose. Also as an ...

Answer from: Radiation Oncologist at Academic Institution

There is evidence that using post-induction volumes is acceptable Yang et al., PMID 28864073.

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Radiation Oncologist at RadiantCare
There are now long-term results from this prospect...

Radiation Oncologist at Cook Radiation Oncology
Do you extrapolate all WHO subtypes or limit to on...

Radiation Oncologist at RadiantCare
This trial contained the following breakdown of WH...

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

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