Unspare treatment.

We all think of larynx cancer as having minimal lymphatic drainage—thus the recommendation to irradiate the larynx alone for early-stage cases. But did you know 16% of early stage glottic cancers that undergo elective neck dissection demonstrate occult nodal disease? While not intentional, conventional 2D and 3D larynx-only opposed lateral fields have necessarily treated immediately adjacent level II-III lymph nodes. This case study details a large nodal recurrence immediately adjacent to the laryngeal target following the modern approach of carotid-sparing IMRT. This, together with a recent SEER analysis reporting significantly worse cancer-specific survival with IMRT vs. 3D-conformal radiation for this indication, leads the authors to suggest we critically assess what we are really achieving with this modern technique, particularly when we consider the small clinical impact of full carotid dose over such a small field. | Depaoli, Pract Radiat Oncol 2022