This region is adjacent to the retropharyngeal space and is contiguous with the pharyngeal wall of the oropharynx with superior extension to the base of skull and inferiorly to the cervical esophagus. Primary tumors in this region are usually large and infiltrate deeply along the retropharyngeal space with lymph node metastasis in the retropharyngeal and cervical nodes.
Because of the extent of most of these tumors at presentation, surgical resection is usually not possible. Radiation therapy is the main therapeutic modality. Consideration of altered fractionation approaches would be reasonable. At Memorial Sloan-Kettering Cancer Center, we would treat the unresectable lesions with cisplatin chemotherapy delayed concurrent with radiation therapy using accelerated fractionation with a concurrent boost to
7,000 cGy to the primary tumor and lymphadenopa-thy; 5,000 to 5,400 would be administered for elective nodal irradiation.
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