Consult note · Clinical Notes
Radiation oncology consultation — re-irradiation
Sep 3, 2026 · R. Lee, MD · 3 pages
G2 › Raman, Priya › Clinical Notes › Radiation Oncology › 2026-09-03 Re-irradiation consult
In packet · tab 8
RADIATION ONCOLOGY CONSULTATION — RECURRENT HEAD AND NECK CANCER
Patient: Priya Raman DOB: 02/19/1965 MRN: TCPT-0048109
Referring: S. Whitaker, MD (Head and Neck Surgical Oncology) Date of service: 09/03/2026
HISTORY OF PRESENT ILLNESS
Ms. Raman is a 61-year-old woman with a history of p16-negative squamous cell carcinoma of the left base of tongue, cT2 N1, diagnosed in 2021. In 2021 she received prior radiation to the left oropharynx and neck at an outside facility, with concurrent cisplatin.C-9 She completed chemoradiation in May 2021C-10 and had a complete response on 3-month PET. Outside treatment records have been requested.
In June 2026 she developed left-sided odynophagia and otalgia. Biopsy on 07/30/2026 confirmed recurrent squamous cell carcinoma at the left base of tongue and vallecula. Restaging PET/CT on 08/14/2026 showed no nodal or distant disease.
PAST HISTORY
Hypothyroidism after radiation (levothyroxine). Prior PEG, removed 2021. Never smoker.
ASSESSMENT
Recurrent, previously irradiated rT2 N0 M0 squamous cell carcinoma of the left base of tongue, p16 negative. Head and neck surgery advises that salvage resection would require total glossectomy with laryngectomy; patient declines.
PLAN
Recommend salvage re-irradiation with intensity-modulated proton therapy, 60 Gy(RBE) in 30 fractions to the recurrent gross disease with margin, without elective nodal coverage. Protons are recommended to limit cumulative dose to the spinal cord, brainstem, mandible and larynx. Physics to obtain the prior plan and build a composite dose assessment.