The Study: This one aims to make post-operative radiation therapy (PORT) following resections of high-risk H&N cancers just a little sweeter. It’s design is borne out of some solid logic: most recurrence risk lies in post-op beds where gross disease once inhabited. This brave phase 2 trial assessed "limited" PORT for 72 patients with resected H&N cancers spanning the oral cavity to hypopharynx (and one unknown primary for good measure). By limited we mean omission of treating any pathologically uninvolved hemi-neck nodal regions. At a median of 4.5 years, there were only two failures in the unirradiated neck, and neither were isolated.
Bottom Line: Not all H&N post-op beds are created equal, and the most appropriate simultaneous dose prescribed to the lowest risk regions may turn out to be zero. | Contreras, ASTRO 2018