POSTOPERATIVE RADIATION

INDICATIONS

Local field only

  • Positive margins when re-operation is not possible

First Echelon Nodes

  • pT4 lesions - deep extra dermal structures
    • invasion of bone
    • cartilage
    • skeletal muscle
  • Perineural invasion either symptomatic or named nerve - treat the nerve as well as ENI

Second Echelon Nodes

RELATIVE INDICATIONS

2 or more of the following are present

  • > 2 cm size
  • > 4 mm in depth
  • Moderately or Poorly differentiated
  • perineural invasion of unnamed nerves
  • close margins when re-operation is not possible

RECURRENT DISEASE

  • for patients with recurrent or persistent disease electively treat regional nodes
  • either surgical excision or a repeated RT may be given to full dose
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