Head and neck nodal coverage

Question 1

Node-negative oropharynx

Answer 1

II-IVa
+VIIa retropharyngeal if posterior pharyngeal wall involvement

Can consider omitting contralateral if well-lateralized

Question 2

Contralateral parotid gland (HPV+ OPX)

Answer 2

Bilateral: Mean <18-26 Gy
Unilateral: Mean <7 Gy

Question 3

Contralateral submandibular gland (HPV+ OPX)

Answer 3

Bilateral Mean <30-39 Gy
Unilateral Mean <10 Gy

Question 4

Oral cavity (HPV+ OPX)

Answer 4

Bilateral Mean <30-50 Gy
Unilateral Mean <30 Gy

Question 5

Superior/middle pharyngeal constrictors (HPV+ OPX)

Answer 5

Bilateral Mean <45-60 Gy
Unilateral Mean <35-45 Gy

Question 6

Inferior pharyngeal constrictors (HPV+ OPX)

Answer 6

Bilateral Mean <20-35 Gy
Unilateral Mean <15-25 Gy

Question 7

Cervical esophagus (HPV+ OPX)

Answer 7

Bilateral Mean <20-35 Gy
Unilateral Mean <15-25 Gy

Question 8

Larynx (HPV+ OPX)

Answer 8

Bilateral Mean <25-40 Gy
Unilateral Mean <15-25 Gy

Question 9

Mandible (HPV+ OPX)

Answer 9

Max point dose <100% of prescribed dose outside PTV
Max point dose <105% of prescribed dose inside PTV

Question 10

Brainstem (HPV+ OPX)

Answer 10

Max point dose <35-54 Gy

Question 11

Spinal cord (HPV+ OPX)

Answer 11

Max point dose <35-45 Gy

Question 12

Cochlea (HPV+ OPX)

Answer 12

Bilateral Mean <20Gy, Max < 35

Question 13

Node-positive oropharynx

Answer 13

Ipsilateral: Ib, II, III, IVa, VIIa (retropharyngeal)
Contralateral: Ib, II, III, IVa, +VIIa if posterior pharyngeal wall involvement
+ipsilateral VIIb (retrostyloid) if bulky upper level II node
+ipsilateral Va/Vb if N3 disease

Question 14

Node-negative oral cavity

Answer 14

Bilateral I-III
+IVa if anterior tongue tumor or extension into oropharynx
+ipsilateral IX (bucco-facial) if buccal mucosal involvement

Question 15

Node-positive oral cavity

Answer 15

Ipsilateral: I-IVa(b)
Contralateral: I-III, +IVa if anterior tongue involvement
+V if level III-IV involvement
+VIIb (retrostyloid) if bulky upper level II node
+IX if buccal mucosal involvement

Question 16

Node-negative hypopharynx

Answer 16

Ipsilateral: II-IVa, +VI for extension into esophagus, postcricoid, and/or apex of piriform sinus
Contralateral: II-IVa, +VI for extension into esophagus
+VIIa bilaterally for posterior pharyngeal wall involvement

Question 17

Node-positive hypopharynx

Answer 17

Ipsilateral: Ib-IVa(b), VIIa, +VI for extension into esophagus, postcricoid, and/or apex of piriform sinus
Contralateral: II-IVa, +VIIa if posterior pharyngeal wall involvement, +VI for extension into esophagus
+VIIb if bulky upper level II node

Question 18

Node-negative larynx (non-glottic)

Answer 18

II-IVa bilaterally
+VI for transglottic or subglottic extension

Question 19

Node-positive larynx (non-glottic)

Answer 19

Ipsilateral: II-IVa(b), Vab
Contralateral: II-IVa
+VI for transglottic or subglottic extension, or ipsilateral N3 disease
+VIIb if bulky upper level II node

Question 20

Node-negative nasopharynx

Answer 20

Bilateral II-V, VIIa, VIIb
Can omit IV and Vb/c

Question 21

Node-positive nasopharynx

Answer 21

N1-2: Bilateral II-V, VIIa, VIIb
+IB if positive level II
Can omit IV and Vc in node-negative neck

N3: Bilateral Ib-IVb, Vabc, VIIa, VIIb