Recommendations Regarding Elective Treatment of Common Head and Neck Cancer Sites

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Given the significant risk for occult nodal involvement in certain sites of the head and neck region:
    • The standard of care has evolved to electively treat such patients:
      • Despite the lack of confirmatory randomized trials
  • Nodal coverage of levels I to III for oral cavity tumors and levels II to IV for oropharyngeal, hypopharyngeal, and laryngeal tumors:
    • Are mandatory as elective treatment
Guidelines for Neck Treatment in Patients with Head and Neck Squamous Cell Carcinomas: Echelons of Lymph Nodes to Be Treated
  • Elective nodal irradiation including the retropharyngeal lymph nodes is added for primary tumors involving the:
    • Nasopharynx, tonsil, pharyngeal wall, and the soft palate
  • Bilateral ENI should be considered for:
    • Tumors arising from or extending to midline structures such as the soft palate, the base of tongue, and the pharyngeal wall
  • Tumor sites such as the hypopharynx and the supraglottic larynx:
    • Require bilateral ENI regardless of the specific tumor stage given high risk for contralateral nodal involvement
  • In contrast, tumor involvement of ipsilateral structures such as the parotid, the buccal mucosa, and selected tonsil cancers warrants consideration of ipsilateral ENI
  • Elective nodal irradiation including level IV lymph nodes:
    • Should be considered in those with tumors involving the tip of the oral tongue:
      • Due direct drainage to this area that bypass the orderly contiguous progression in the anterior jugular nodes
  • Involvement of the ipsilateral level V lymph nodes in node-negative oral cavity tumors is rare:
    • Occurring in less than 1% of the cases , and does not warrant ENI:
      • However, with increasing involvement of levels I to III or the involvement of level IV, the risk for level V involvement increases warranting ENI
  • In contrast, involvement of only the true vocal cords does not warrant ENI due to the paucity of lymphatic drainage
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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