Post-op RT for Larnyngeal/hypopharynx Cancer Flashcards
Target dose for post-op RT to the region of resected gross disease
60 Gy in 2 Gy fractions
Target dose for post-op RT to the region of resected gross disease for positive margin?
66 Gy in 2 Gy fractions for positive margins
What is the post-op RT dose for operative bed of primary and LNs
57 Gy (intermediate dose)
What is the post-op RT dose for nondissected at-risk regions including nondissected at-risk nodal levels?
54 Gy
What important part should be included in the RT field for nondissected at-risk regions with 54 Gy?
Stoma
In which situation should you increase RT dose to stoma?
If stoma or tracheostomy is made emergently through tumor, the RT dose should be increased up to 60-66 Gy depending on the margin status.
RT technique for post-op RT for larynx/hypopharynx
IMRT or VMAT or scanning beam proton therapy can be used in capable centers
Any particular thing you would like consider for SIM for post-op RT for larynx/hypopharynx
Wiring scars helps define the operative bed.
Especially if there was neck disease with ECE, consider bolus for scars and also consider bolus for stoma if at increased risk due to disease proximity.
What IGRT you would use?
Daily kV imaging
What RT coverage should your PTV have?
> 95% coverage
Constraints for parotid gland
bilateral mean < 26 Gy
Constraints for submandibular gland
bilateral mean < 30 Gy
Constraints for spinal cord
Dmax < 45 Gy
Constraints for brainstem
Dmax < 45 Gy
Constraints for mandible
Dmax < 70 Gy
