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Submitted Case

2022
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Patient Information: (Do not provide name of the patient)
Age
  70M KPS70 heavy smoker > 75PY + daily EtOH; contralateral neck recurrence after chemoRT for HPV-driven left tonsil cancer.
Diagnosis
  8/2021: diagnosed with p16+ cT2N1M0 SCC of the left tonsil – (node: no ENE, reniform shape preserved but FDG-avid). FFL: 2 cm exophytic firm friable left tonsil mass limited to tonsillar fossa with some extension medially towards soft palate, does not involve glossotonsillar sulcus or BOT. ——————– PET1 4 mo after chemoRT: PETCR (but a ? spine lesion)——— PET2 8mo after chemoRT: "New 1.1 x 0.8 cm FDG avid right level 2 node with maximal SUV of 4.7"! see pic
Imaging
  see pix
Pathology
  "patchy" staining for p16
Overall Oncology Management Plan
Surgery (biopsy)
  at recurrence, right selective neck dissection –> 19 nodes level 2-4 harvested; one level 2 node replaced with malignancy and has ENE
Chemotherapy (if given, what is the regimen)
  Concurrent weekly cisplatin 40 mg/m2 – tolerated poorly; skipped wk 5-6 due anorexia; final wk 7 only got 20 mg/m^2
Radiation Therapy (fields, dose)
  to the gross tumor and to elective neck – ipsilateral only – to a total dose of 70 Gy and 63 Gy in 35 fractions between 8/25/2021 and 9/14/2021 with dose-painted IMRT photons. Daily cone beam guidance was used.
Radiation Treatment Plan
Defining target and margin
  Should I have ignored the p16+ status of the initial cancer and treated his b/l necks?
Images
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Session Name
  Head and Neck Specialist Dr. David Sher- July 25, 2022
Session ID
  12089
created_by
  7717
post_id
  12089
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