Slight Dose Reduction in Radiation Given to Elective Nodal Regions for HNC Is Safe

Background: For decades, radiation oncologists have treated regions that might harbor subclinical disease with 50 to 56 Gy in 1.8 or 2.0 Gy daily fractions. Diagnostic changes since the days of Gilbert Fletcher have been dramatic and we now reliably detect much smaller levels of nodal disease. The authors claim radiobiologic models suggest that 34 to 40 Gy is sufficient for modern subclinical disease. Objective: To ascertain whether reduced doses for elective nodal coverage is effective in definitive radiotherapy (RT) for head and neck cancer (HNC). Design: Prospective, multicenter, single-blind, randomized trial from the Dutch Head and Neck Society. Participants: Eligible patients had cT2-4N0-2M0 squamous cell cancers of the oropharynx, larynx, or hypopharynx. Methods: Workup included endoscopic examination, CT, or MRI (but no PET), and ultrasound of the neck with FNA (fine-needle aspiration). PET images were obtained during the planning process, with the patient in the treatment po more...