Treatment options for early stage oropharyngeal cancers include:
1. Definitive Radiation alone 70 Gy in 35 fractions (preferred)
2. Definitive Radiation to 50 Gy then 20 - 30 Gy delivered via brachytherapy
3. Surgical resection with neck dissection +/- adjuvant chemoradiation or radiation as needed.
These patients can expect to do well, with good local control ~80 -100% and good overall survival 70-100% at 5 years
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Early stage oropharyngeal cancers include T1N0 and T2N0 tumors.
Treatment options include:
- Definitive radiation alone
- Surgical resection with neck dissection +/- chemoradiation or radiation adjuvantly
There is a lack of Level I or even Level II evidence to definitively guide treatment. Data comes from single institution retrospective analyses from the 1980's demonstrating high rates of control. Some of the older data have worse outcomes, but keep in mind that this pre-dates 3D CRT never mind IMRT and newer treatment techniques.
5 yr LC:
T1N0 = 90-100%
T2N0 = 70-90%
5yr OS:
T1: 80-100%
T2: 70-90%
Definitive radiation can be delivered as EBRT alone or in combination with brachytherapy. A standard dose for EBRT alone is 70 Gy in 35 fractions. There is experience and retrospective data showing that adding brachytherapy after 50 Gy of EBRT has good local control rates. Altered fractionation, such as concomitant boost may be considered; however, the reasoning is based on extrapolation primarily from RTOG 90-03. This study showed improved local control, but the study population was locally advanced tumors, although some were T3N0's.
Special considerations:
Soft palate and pharyngeal cancers tend to drain bilaterally to the neck and retropharyngeal lymphatics.
Early stage tonsillar cancers drain unilaterally. Bilateral drainage in advanced cancers.
Treatment Planning
Plan by IMRT!
GTV = Gross tumor & suspicious LNs
CTV70 = GTV + 1 cm
CTV64 = CTV70 + LN areas at risk (usually regional LN and LN region above and below)
CTV56 = LN region considered to be at lower risk (adjacent to CTV60 LN groups)
PTV = CTV + 3 mm
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