Cervical nodal level V can safely be omitted in the treatment of locally advanced oropharyngeal squamous cell carcinoma with definitive IMRT

Patterns of Treatment Failure and Postrecurrence Outcomes Among Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma After Chemoradiotherapy Using Modern Radiation Techniques

“…For each patient, the recommended course of treatment was formulated with the input of a multidisciplinary team including a radiation oncologist, medical oncologist, head and neck surgeon, pathologist, and radiologist. Details regarding head and neck IMRT planning have previously been described in detail 5,[10][11][12][13] ; the IMRT field design evolved over the course of the study period based on observed patterns of treatment failure (eAppendix in the Supplement).…”

Human Papillomavirus-Related Non-Metastatic Oropharyngeal Carcinoma: Current Local Treatment Options and Future Perspectives

“…If the disease can be classified as low-risk [ 21 ] (i.e., if the patient is a non-smoker with only a single ipsilateral positive LN with no signs of ENE using high-quality imaging), RT can be safely offered as a single treatment modality [ 36 , 37 , 38 ]. Evidence from single institution series demonstrated the efficacy of IMRT, when precise delineation of the target volume and meticulous planning techniques were used.…”

“…Evidence from single institution series demonstrated the efficacy of IMRT, when precise delineation of the target volume and meticulous planning techniques were used. Based upon a retrospective analysis of 408 patients with OPSCC (p16 status was available in 165 patients (40.4%) out of which 82 patients (66%) were HPV+) by Gutiontov et al [ 37 ], level V lymphatics can be safely omitted from the clinical target volume (CTV), unless there are positive nodes within this anatomical area. The expected risk of regional nodal recurrence in ipsilateral or contralateral level V is 0%, with the vast majority of regional nodal recurrences located in ipsilateral level II [ 37 ].…”

“…Based upon a retrospective analysis of 408 patients with OPSCC (p16 status was available in 165 patients (40.4%) out of which 82 patients (66%) were HPV+) by Gutiontov et al [ 37 ], level V lymphatics can be safely omitted from the clinical target volume (CTV), unless there are positive nodes within this anatomical area. The expected risk of regional nodal recurrence in ipsilateral or contralateral level V is 0%, with the vast majority of regional nodal recurrences located in ipsilateral level II [ 37 ]. With the sparing of level V lymphatics, RT-related morbidity can be lowered by reducing the risk of long-term dermatitis, brachial plexopathy, and shoulder dysfunction.…”

In reply to McDowell et al

“…One of our patients developed an isolated contralateral retropharyngeal node recurrence, but other series have suggested that omitting the contralateral upper level 2 and retropharyngeal nodes is safe and improves quality of life . Sparing the contralateral neck is not the only volume deintensification approach in oropharyngeal cancer: efforts have also been made to spare the ipsilateral uninvolved levels 1b and 5, and perhaps the time for a prospective clinical trial to investigate limited nodal RT in tonsillar tumors has come.…”