Post-operative management of resectable sublingual gland cancer with no clinical or radiological cervical lymph node involvement (cN0, M0)
Clinical scenario
This protocol addresses patients with resectable sublingual gland cancer in whom pre-operative staging shows no clinical or radiological evidence of cervical lymph node metastasis (cN0) and no distant metastasis (M0). Surgery is the mainstay of treatment, and the protocol defines the recommended post-operative approach.
Key staging consideration
Even when lymph nodes appear uninvolved at imaging, occult nodal involvement rates in certain anatomical sites and tumour subtypes can substantially exceed 20%, which informs elective nodal management decisions made at the time of surgery.
Post-operative treatment (partial overview)
Following resection, the protocol involves post-operative radiotherapy directed to the primary tumour region and to the relevant neck levels. The specific radiation fields and approach are shaped by the pathological findings — including the completeness of resection and the status of the neck. The complete protocol details are available via the link below.
References
DOI: 10.1016/j.esmoop.2022.100602
- Surgery is the mainstay of treatment for primary resectable disease with the traditional open approach being the most widely used, although endoscopic and robot-assisted approaches have recently been described.
- In oral cavity (levels I, II, III and IV) and oropharyngeal (levels II, III and IV) minor SGC, and in high-grade MEC and AdCC, the occult rates largely exceed 20% and END is indicated.
- Post-operative RT is indicated for all cases of pN+ neck.
- After incomplete resection, a dose of 33 x 2 Gy is described for the primary tumour region plus a 1 cm margin, with 30 x 2 Gy after a clear resection.
- A dose of 30 x 2 Gy is recommended for the involved level, and 33 x 2 Gy in case of extranodal disease.
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