Hi Nilesh,
Perinodal extension by itself, would be a criteria for concomitant chemo-radiotherapy in a squamous cell carcinoma.
For a muco-epidermoid, I guess there would not be evidence to offer post-op concomitant chemoradiotherapy.
I'm also not sure of efficiency of cisplatin as a concomitant therapy for muco-epidermoid Ca. So it would be very difficult to justify, based on evidence, use of post-op CTRT. This young man does seem to have an aggresive disease, so you should discuss with patient about benefit:risk and would not be blamed for extrapolating results of SCC to this scenario. It also depends on what your medical oncologist feels about it.
I would suggest dose escalation to level IB to 66 Gy instead [since only minimal PNE].
I agree with Andrew's suggestion of treating the primary site as well if it was in the inferior buccal mucosa and very close to the submandibular region. If, however, the margins were really wide [>0.5cm] and the primary was quite far from the level IB needing a significant increase in field size, we could consider observing it. He is 20 yr… and has a long way to go.. and hence should minimize radiation volumes. Do limit dose to contralateral oral cavity, submandibular glands and also larynx, when treating the neck.. especially the lower dose volumes.
I was also thinking of the extent of lymph node regions to be treated.. do look into possibility of reducing dose to ipsilateral level 3/4 to 50-54 Gy, keeping dose to level II till 60 Gy and IB as mentioned above, would need dose escalation.
Andrew… any specific reason why you would suggest 70 Gy for LN size >4mm. Even with radiological size criteria in a primary Squamous Cell Ca, it is suggested that 1cm should be cut-off [1.5cm for level II]. Would you want to elaborate on your thought?
Also, very important to educate patient to refrain from any tobacco/ betel nut, etc use to avoid risk of future SCC.
Regards
Pranshu
