6
Radiotherapy
➤ 4.11: Patients for whom no primary site is pathologically identified
at the time of surgery may benefit from treatment to the anatomic
mucosal regions at-risk of harboring the occult primary site
as defined in Recommendation 4.1. Nodal volumes requiring
treatment are similar to those in Recommendations 4.5-4.7. (Strong
recommendation; EB-B-I)
➤ 4.12: Adjuvant radiotherapy should not be administered to patients
with a single pathologically positive node without ENE after high-
quality neck dissection (definition in ASCO's management of the
neck practice guideline) and in whom after a thorough evaluation no
primary tumor is identified. (Strong recommendation; EB-B-I)
➤ 4.13: Adjuvant radiotherapy should be administered to patients with
multiple pathologically involved nodes and/or pathologic evidence of
ENE. (Strong recommendation; EB-B-I)
➤ 4.14: Adjuvant radiation dose to the dissected regions of neck should
be the equivalent of 60 Gy to the node levels that harbored gross
resected disease and 50 Gy to regions beyond this thought to be
at risk of microscopic residual disease. Nodal regions from which
nodes were determined to have pathologic ENE may be considered
for higher doses of adjuvant radiation, the equivalent of 60-66 Gy.
(Moderate recommendation; EB-B-I)
