سرطان الغدة النكفية بعد الاستئصال الجراحي: العلاج عندما لم تُحقَّق هوامش جراحية سلبية

References

DOI: 10.1200/JCO.21.00449

• Postoperative RT should be offered to patients with tumors with the following features: high-grade tumors, positive margins; perineural invasion; lymph node metastases; lymphatic or vascular invasion; and T3-4 tumors.
• Postoperative RT may be offered to patients with tumors with close margins or intermediate-grade tumors.
• In postoperative cases, the high-dose target should cover the salivary gland surgical bed and appropriate nodal levels.
• Postoperative radiotherapy when conventionally fractionated should be at least 60 Gy to the high-dose target.
• Radiation should be initiated within 8 weeks of surgery.
• In the case of perineural invasion, the associated nerve(s) may be covered with an elective or intermediate dose to the skull base.
• Coverage of the involved nerve to the base of skull with an elective or intermediate dose (46-54 Gy in 2 Gy fractions) may be reasonable to reduce the risk of retrograde nerve failure toward the base of skull.
• Elective neck irradiation may be offered in patients with cN0 disease for the following indications: T3-T4 cancers or high-grade malignancies.