Automated radiological report generation can alleviate clinical workloads and eliminate observer variability. However, standard free-text generation models pose hallucination risks in dense regions and fail under data scarcity. We address these challenges in Head and Neck Cancer (HNC) from contrast-enhanced CT (CECT) imaging. To enforce factual safety, we reformulate report generation as an anatomically grounded, multi-label, structured reporting task, predicting localized tumor involvement across a hierarchical clinical schema. To bridge the visual gap from missing metabolic imaging (e.g., PET), we introduce SGRNet (Spatially Guided Radiology Network), incorporating two low-cost spatial priors: automated organ segmentations and weakly supervised tumor localization maps modeled via 3D Gaussian heatmaps. These priors are dynamically integrated via spatial feature modulation to guide the network toward subtle tumor-induced structural alterations. Evaluated on a multi-centric dataset of 184 paired HNC CECT volumes and reports, on five clinically salient, densely packed anatomical subsites, SGRNet achieves a mean Average Precision (mAP) of 0.60, an 8.8 percentage-point absolute improvement over strong volume-only 3D baselines.

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