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- FIGURE 29.2-16. (A) A patient with a T2, N0 squamous cancer of the
- soft palate. He was treated with external beam radiation therapy to
- the primary site and to both necks. Opposed lateral portals were used
- with a low anterior neck field. (B and C) The simulated fields are
- shown. The primary site and both upper necks received 4500 cGy, after
- which a spinal cord block was placed. The primary site and upper necks
- were then treated to 5400 cGy, including the retropharnyngeal nodes.
- The primary site was treated to a total of 6840 cGy. The patient is
- asked not to swallow during treatment, so the palate remains in
- position. Adequate margin is placed around the palate in its plane of
- motion to avoid geographic miss. Fraction size is 180 cG/day. The
- lower neck is treated with an anterior portal to 5000 cGy/5 weeks,
- thereby delivering elective nodal irradiation to that site. The
- posterior necks are boosted with electrons to 5400 cGy to protect the
- spinal cord. The spinal cord is protected at the junction of the
- lateral fields with the low anterior neck field by a midline block in
- the low neck field. This block also protects the larynx. For this
- purpose, the field is purposely junctioned above the thyroid notch but
- below the hyoid bone. (D) The patient had no evidence of disease at
- 2.5 years.
-