Teaching new dogs old tricks.

July 28, 2017. Postoperative radiation (PORT) doses for head and neck cancer have been up for debate since 1983. That is when the RTOG opened this large Phase 3 trial to determine optimal PORT dosing based on known risk factors for recurrence. The (really) long-term results have now been published in the Red Journal. There doesn’t seem to be any benefit to dose escalation above ~60 Gy, although there is a benefit to avoiding delays. Intermediate risk factors (i.e, number of involved nodes) are cumulative, and outcomes are largely driven by positive surgical margins and extranodal extension. While these results aren’t groundbreaking, the paper is an absolute must read for a couple of reasons. First, it describes 20 years of outcomes for H&N cancer treated with surgery + PORT (Figure 2 is an instant classic). Second, it is a clear and concise explanation of a murky topic--namely, the rationale for H&N PORT doses--as written by people who were there through it all. So check out this new refreshing critique of an old tried and true technique.