H&N neck levels

Question 1

when should contralateral neck irradiation be offered following primary surgery to an oral cavity tumour and ipsilateral neck dissection

when should it be considered

Answer 1

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

Question 2

When can unilateral RT be considered for a tonsillar tumour instead of bilateral

Answer 2

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

Question 3

If level 4A or 5b is involved, what levels must also be included

Answer 3

4B & 5C

Question 4

If level 2 nodes are involved, which levels must also be included

Answer 4

1b, 5a&b, 7b

Question 5

What level should be included if 1b or 4 is involved

Answer 5

level 5

Question 6

what levels should be treated for a nasopharyngeal tumour

Answer 6

2,5,7A

Question 7

oral cavity
T1-2 N0 , >1cm lateral to the midline
What nodal levels should be treated

Answer 7

Ipsilateral:
1a-4a; 9 if buccal mucosa involved

Contralateral:
None

Question 8

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

Answer 8

Ipsilateral: 1a-4a
Contralateral: none

9 if buccal mucosa involved

Question 9

Oral cavity
T2N0, <1cm lateral to the midline or T3N0
What nodal levels should be treated

Answer 9

Bilateral 1a-4a
9 if buccal mucosa involved

Question 10

Oral cavity
T2N1, <1cm from midline
What levels should be included

Answer 10

1a-4a bilaterally
9 if buccal mucosa involved

Question 11

Oropharynx
T1-2 N0, lateralised

Answer 11

Ipsilateral: 2-4a (1b if oral involvement)
Contralateral: none

Question 12

Oropharynx
T1-2 N0, <1cm from midline

Answer 12

Ipsilateral: 2-4a (1b if oral involvement)
Contralateral: 2-4a

Question 13

Oropharynx
Tany N1

Answer 13

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)

Question 14

Oropharynx
Tany N2a-2b (single - multiple ipsilateral nodes, <6cm)

Answer 14

Ipsilateral: 1b-4a, 5a&b, 7a&b
Contralateral: 2-4a (& 7A if posterior pharyngeal wall)

Question 15

Oropharynx
N2c - contralateral or bilateral nodes

Answer 15

Dependent on node positivity
2-4a bilaterally at least
& 7A if posterior pharyngeal wall

Question 16

Oropharynx
N3 - node >6cm (N3a) or ECE+ (N3b)

Answer 16

Ipsilateral: 1b-4a, 5a&b, 7a&b
Contralateral: 2-4a
7A if posterior pharyngeal wall bilaterally
+ include locally invaded structures

Question 17

Nasopharynx
What CTV
T1-2 N0

Answer 17

CTV-60: CTV-65 +5mm, whole nasopharynx, inferior sphenoid sinus
Nodes: Bilateral 2A-5A, 7A&B

Question 18

Nasopharynx
What CTV
T1-2 N+

Answer 18

CTV-60: CTV-65 +5mm, whole nasopharynx, inferior sphenoid sinus
Nodes: Bilateral 2A-5A&B, 7A&B

Question 19

Nasopharynx
What CTV
T3-4 N0

Answer 19

CTV-60: CTV-65 +5mm, whole nasopharynx, whole sphenoid sinus & ipsilateral cavernous sinus
Nodes: Bilateral 2A-5A, 7A&B

Question 20

Nasopharynx
What CTV
T3-4 N+

Answer 20

CTV-60: CTV-65 +5mm, whole nasopharynx, inferior sphenoid sinus
Nodes: Bilateral 2A-5A&B, 7A&B

Question 21

Hypopharynx
T1-2N0

Answer 21

Ipsilateral: 2-4a
Contralateral: 2-4a

Question 22

Hypopharynx
T-any, N1-2b

Answer 22

Ipsilateral: 2-4a
Contralateral: 2-4a
include 6 if pyriform sinus apex involved, post cricoid space or oesophageal extension; 7A if posterior pharyngeal wall involvement

Question 23

Hypopharynx
Tany N2c - bilateral or contralateral nodes

Answer 23

Depends on which nodes are positive
include 6 if pyriform sinus apex involved, post cricoid space or oesophageal extension or node positive ; 7A if posterior pharyngeal wall involvement

Question 24

Hypopharynx
Tany N3 - >6cm or ECE

Answer 24

Ipsilateral: 2-4a
Contralateral: 2-4a
include 6 if pyriform sinus apex involved, post cricoid space or oesophageal extension or node positive ; 7A if posterior pharyngeal wall involvement

Question 25

Larynx T1-2 N0

Answer 25

None

Question 26

Larynx T3-4 N0

Answer 26

Ipsilateral: 2-4a Contralateral: 2-4a 6 if subglottic involvement

Question 27

Larynx Tany N1-2b

Answer 27

Ipsilateral: 1b-4a, 5a-b, 7b Contralateral: 2-4a 6 if subglottic involvement

Question 28

Larynx Tany N2c - bilateral or contralateral nodes

Answer 28

Ipsilateral: 1b-4a, 5a-b, 7b Contralateral: depends on nodal involvement 6 if subglottic involvement

Question 29

Larynx N3

Answer 29

Ipsilateral: 1b-4a, 5a-b, 7b Contralateral: 2-4a 6 if subglottic involvement