Post-Operative Head and Neck Cancer Radiation Therapy Contouring Guidelines

Dose and Fractionation Guidelines

The National Comprehensive Cancer Network recommends postoperative radiotherapy with a dose of 60-66 Gy (2.0 Gy/fraction) for high-risk features, such as extracapsular nodal extension and/or positive surgical margins, with concurrent cisplatin recommended for these patients 1, 2, 3
For patients with high-risk features, postoperative radiotherapy should deliver 60-66 Gy (2.0 Gy/fraction) to regions with microscopically positive surgical margins and extracapsular nodal extension, with concurrent chemotherapy (typically cisplatin 100 mg/m² every 3 weeks for 3 doses) added for these patients 2, 3, 4
The time from surgery to completion of radiotherapy should be kept as short as possible, ideally less than 6 weeks, for patients with high-risk features 1, 4

The National Comprehensive Cancer Network recommends contouring the entire surgical bed of the primary tumor with appropriate margins, requiring thorough understanding of natural history, anatomy, clinical circumstances, and imaging to guide target delineation 1, 3
For well-lateralized tonsillar cancer with N0-N1 nodal category, unilateral radiotherapy is recommended, while for lateralized tonsillar cancer without extracapsular extension, unilateral radiotherapy may be delivered after careful discussion of risks and benefits 4

The National Comprehensive Cancer Network recommends IMRT as the predominant technique, useful in reducing long-term toxicity by reducing dose to major salivary glands, temporal lobes, mandible, auditory structures, and optic structures 1, 5
Altered fractionation should be used in patients with T3 N0-1 oropharyngeal squamous cell carcinoma treated with definitive radiotherapy who do not receive concurrent systemic therapy, with schedules delivering at least 1000 cGy/week recommended 1, 4, 5

The National Comprehensive Cancer Network recommends post-treatment baseline imaging of primary site and neck within 6 months of treatment, with complete head and neck examination performed at regular intervals: every 1-3 months in year 1, every 2-6 months in year 2, every 4-8 months in years 3-5, and annually thereafter 6, 8
Thyroid-stimulating hormone (TSH) should be checked every 6-12 months if the neck was irradiated, and salvage surgery plus neck dissection is recommended as indicated for patients who do not have a complete clinical response to therapy 3, 6, 8