Neck game strong.

We bet in residency a chart outlining the neck nodal levels for each primary site hung on a nearby wall. It had been there for as long as anyone knew. Who put it there? The chair? God..? Nobody knows for sure. Fortunately, Gregoire and company have published an update of their Y2K classic. It’s basically a systematic approach to outlining which cervical nodal regions should be covered in the low-dose volume based on primary tumor site. As you’d imagine, bilateral levels II-IV are almost always covered. But the paper gives a good outline of what other levels to include and when ipsilateral-only treatment could be considered. In reading the paper, you can see folks are largely going to a two-volume approach with the high-dose CTV being GTV + 5 mm DAHANCA style. Given that it’s 2019 and all, this should really be a web-based app—perhaps an interactive CT module where you click the primary tumor site and involved nodal levels and it returns the recommended volumes to include (ahem, eContour).  TBL: It’s time to print off another neck nodal level chart. | Biau, Radiother Oncol 2019