Help with head and neck cases!

[BraggPeak]

I have a patient with metastatic scc of skin, with mets to intra parotid nodes. He's not a surgical candidate for multiple reasons, so I am doing rt alone after tumor board discussion. The primary was already treated with rt. The intra parotid nodes are fairly superficial, so I am using bolus. I'm also treating neck comprehensively and and pre/post auriculR nodes. The intra parotid nodes are right by ear, and bolus partially goes over ear. Do I need to be worried about cartilage of ear? I am using conventional fractionation (2 Gy)


2nd question: when treating post-op, node positive scc of lower lip what sort of bite block etc do you use? I was going to have a wax mold between lip and teeth. Just curious what other centers do.


3rd case-
T3 No supra glottic larynx scc.
Node negative per PET. The CT shows a 5 mm level 3 node on clntralateral side,which radiologist did not call. I showed it to him and he was totally unimpressed with such A small node. Same with the head and neck.

I wS gonnA treat primary + margin to 70 and bl levels 2-4 to 50 in 2 gy. Thoughts?

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[Palex80]

1. How high are you gonna take the dose? Without surgery and/or chemo this sounds rather palliative. I wouldn't have any issues as long as you stay around 66 Gy or so. Going higher may even fry the N. facialis for all you we know...

2. We don't use much of a mold, actually... We only use a mold if we need to shield for secondary electrons in case of metal teeth fillings.

3. I probably have quite some 5mm lymph nodes in my neck as well. Lots of people. I wouldn't worry much about it, unless you have reasons to think it is affected. You can try ultrasound & FNA if you want to. Are you gonna give chemo or are you treating only with RT? If no chemo, then I would probably do CCB.