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 guidelines) would prompt you to offer RT?

What dose/fractionation/volume do you utilize? (Is it ok to de-escalate from 60Gy to 50Gy based on the ECOG trial?)

Answer from: Radiation Oncologist at Academic Institution

I would base my recommendation on the standard and conventional indications for PORT, which in this case of an early-stage primary tumor with negative margins, would comprise the presence of PNI, LVI, close (<3-5 mm) margins, single node >3 cm, or multiple positive nodes. I assume there is no ...

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Radiation Oncologist at University of Florida
Close margins less than 3 mm, PNI, multiple positi...

Radiation Oncologist at UCLA Medical Center
I totally agree with Dr. @William M. Mendenhall no...

Answer from: Radiation Oncologist at Academic Institution

Indications: Dr. @Michael Xiang gave a very nice summary of the indications for treatment as well as the nuances, and that even within the non-ENE nodal disease (as most of the post TORs recommendations are based on neck per ECOG and our own experience), there is a gradation of risk. On the oth...

Answer from: Radiation Oncologist at Academic Institution

This question is only controversial because the accepted standard treatments for low-intermediate risk p16+ patients are either a hammer or do nothing at all.The risk of relapse for low-intermediate risk patients is still around 12%, of which a quarter will fail in a fashion not amenable to salvage ...

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

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