Scrap the primaries.

This happens a lot. A patient with a bulky neck node from p16+ head and neck (H&N) cancer has a small tonsillar primary. Is it necessary to irradiate the primary—with the associated toxicity—if completely excised? This single-arm trial from UPenn actively avoided radiation to the primary site (if T1/2 and no adverse features) in patients who otherwise had indications for adjuvant radiation to the neck. Most patients had T1 primaries in the tonsil. They were able to get the median dose to the primary site to <37 Gy with 0% feeding tube dependance at last follow-up. At 2 years, only 1 of 60 patients had a local recurrence, and it was surgically salvaged. Only two had distant failures, and survival was 100% at 2 years. TBL: Low-risk primary H&N tumors may not merit adjuvant radiation independent of the regional disease it bears. | Swisher-McClure, Int J Radiat Oncol Biol Phys 2019