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Stage I and II
T1-2 N0 M0
High dose RT
Surgery impractical
Stage III and IV
T1-4 N0-3 M0/1
Concurrent chemo + RT
Cisplatin-based chemo regimen
Surgery impractical
Radiotherapy management
Prophylactic bilateral irradiation
CT with contrast and MR co-registeration
Dental assessment
Weekly review by H+N team
Routine reviews by SALT + dietician
Weekly FBC
Weekly weight
Reviewed until acute SE settled
Radiotherapy essentials
70Gy/35#/7 weeks
54-60Gy for high risk areas
Category 1 pt
Technique: IMRT/VMAT
CBCT
Supine
Thermoplastic mask
Dentures removed
OARs:
Oral cavity
Optic nerve
Eye
Cord
Brain stem
Parotid
mandible
Larynx
CTV must incude
Nasopharynx
Base of skull
Clivus
Sphenoid sinus
Maxillary sinus
Irradiation of level II, III, IV, V nodal areas