H&N neck levels Flashcards
when should contralateral neck irradiation be offered following primary surgery to an oral cavity tumour and ipsilateral neck dissection
when should it be considered
Offer contralateral RT if:
- T3-4 tumour (>4cm or locally invasive)
- ≥2 nodes positive in ipsilateral neck
- any ECE within the ipsilateral neck
- primary <10mm from midline
Consider if:
-single ipsilateral LN and no ECE
When can unilateral RT be considered for a tonsillar tumour instead of bilateral
T1-2N0, well lateralised tumour
T1-2 N2b (multiple ipsilateral nodes, <6cm) - if 1-2 nodes only, both <3cm and located only in levels 2 & 3
If level 4A or 5b is involved, what levels must also be included
4B & 5C
If level 2 nodes are involved, which levels must also be included
1b, 5a&b, 7b
What level should be included if 1b or 4 is involved
level 5
what levels should be treated for a nasopharyngeal tumour
2,5,7A
oral cavity
T1-2 N0 , >1cm lateral to the midline
What nodal levels should be treated
Ipsilateral:
1a-4a; 9 if buccal mucosa involved
Contralateral:
None
Oral cavity
T2 N1, >1cm lateral to the midline
What nodal levels should be treated
Which additional level should be included dependent on which nodal level being positive
Ipsilateral: 1a-4a
Contralateral: none
9 if buccal mucosa involved
Oral cavity
T2N0, <1cm lateral to the midline or T3N0
What nodal levels should be treated
Bilateral 1a-4a
9 if buccal mucosa involved
Oral cavity
T2N1, <1cm from midline
What levels should be included
1a-4a bilaterally
9 if buccal mucosa involved
Oropharynx
T1-2 N0, lateralised
Ipsilateral: 2-4a (1b if oral involvement)
Contralateral: none
Oropharynx
T1-2 N0, <1cm from midline
Ipsilateral: 2-4a (1b if oral involvement)
Contralateral: 2-4a
Oropharynx
Tany N1
Ipsilateral: 1b, 2-4a & 7A if posterior pharyngeal wall involvement
Contralateral (if <1cm to midline): 2-4a & 7A if posterior pharyngeal wall involvement
Consider unilateral treatment only if well lateralised primary
(>1cm from midline, not involving base of tongue, posterior pharyngeal wall or extension onto adjacent soft palate by >10mm)
Oropharynx
Tany N2a-2b (single - multiple ipsilateral nodes, <6cm)
Ipsilateral: 1b-4a, 5a&b, 7a&b
Contralateral: 2-4a (& 7A if posterior pharyngeal wall)
Oropharynx
N2c - contralateral or bilateral nodes
Dependent on node positivity
2-4a bilaterally at least
& 7A if posterior pharyngeal wall
