A patient with T3N0 squamous cell carcinoma of the supraglottis is planned for primary radiotherapy. Which statement about elective nodal irradiation is most accurate?

• A Bilateral nodal irradiation is not required because the primary is above the glottis
• B Only ipsilateral levels II–III need coverage given N0 status
• C Elective neck treatment should be deferred until nodal recurrence occurs
• D Elective bilateral neck irradiation is recommended due to the rich bilateral lymphatic drainage of the supraglottis ✓

Explanation

The supraglottis has abundant bilateral lymphatic drainage and carries a high occult nodal metastasis rate (30–40%), even in clinically N0 necks. Current guidelines recommend bilateral elective nodal irradiation (or bilateral selective neck dissection levels II–IV) for T2–T4 supraglottic carcinoma regardless of N-stage. Unilateral or deferred treatment is associated with unacceptably high rates of contralateral nodal failure.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.