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EHNS-ESTRO H&N course
Florence, June 2016
• The entire operative bed (identified by inflammation, edema,
fibrosis, …) should be included in the CTV
• In case of pathological involvement of level II, delineation of
the
retrostyloid space
(level VIIb)
• In case of pathological involvement of level IV and/or Vb,
delineation of the
subclavicular fossae
(level IVb and/or Vc)
• For pharyngeal primaries with node positive neck, inclusion of
the retropharyngeal nodes (level VIIa)
• When a pathological node is located at the boundary between
two levels (e.g. level Ib and II), delineation of the two levels
• When pathological node(s) abut a muscle (e.g. SCM or para-
spinal), delineation of the muscle by 10-20 mm in all
directions
Recommendations for the post-operative
neck
Grégoire et al., 2006
EHNS-ESTRO H&N course
Florence, June 2016
H&N IMRT practice heterogeneity
among Dutch Radiation Oncologists
Rasch et al., 2007