A 58-year-old male, chronic smoker and tobacco chewer for more than 25 years, presented with progressive difficulty swallowing, change in voice, severe throat pain radiating to the ear, and significant weight loss over the last 4 months. On examination: * Ulceroproliferative growth involving left tonsillar region extending to base of tongue * Multiple palpable cervical lymph nodes on left side * ECOG Performance Status: 2 Investigations: * Biopsy: Moderately differentiated squamous cell carcinoma * Contrast CT Neck: Locally advanced oropharyngeal mass with ipsilateral nodal involvement * PET-CT: No distant metastasis * Stage: T3N2M0 – Stage IVA Patient is discussed in tumor board for definitive treatment planning. Questions for PG discussion: 1. What is the standard of care in this locally advanced head and neck cancer case? 2. Would you prefer surgery followed by adjuvant RT or concurrent chemoradiation? Explain your reasoning. 3. What radiation technique would you choose — 3DCRT, IMRT, or VMAT? Why? 4. Dose prescription and fractionation protocol you would plan in this patient? 5. Organs at risk that should be carefully contoured during planning? 6. How would you reduce xerostomia and radiation-induced mucositis? 7. Indications for prophylactic PEG tube insertion before treatment? 8. What chemotherapy regimen is commonly combined with radiation in such cases? 9. How would you assess treatment response after completion of therapy? 10. Major acute and late complications expected in this patient? 11. If residual disease persists after chemoradiation, what would be the next management step? 12. What prognostic factors significantly affect survival in oropharyngeal carcinoma? Discussion open for Radiation Oncologists, Medical Oncologists, ENT surgeons, and PG residents.
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