Chapter 21 - Rads, Systemic Tx H/N CA

Question 1

Benefit of adding chemo to radiation

Most common H/N chemo

Answer 1

Chemo potentiates effects of RT

Cisplatin- most common chemo for H/N chemorads

Question 2

When to use postop chemorads

Answer 2

ECS, pos marg

Question 3

Definitive H/N Rads doses

Answer 3

66-70 Gy definitive gross
Usually once/day 6-7 wk, 1.8-2.25 Gy per day

High risk elective neck- 60
Low risk- 54
Postop- 66

Question 4

How radiation kills cells

Answer 4

ROS

Strand breaks

Question 5

Who cannot be Tx with RT

Answer 5

Coll Vasc Dz
Hypersensitivity (Atax Telang)
Prego esp 1-2 tri
Xeroderma, Li Fraumeni INC risk secondary cancers

Question 6

When to consider induction chemo

Answer 6

Hypo/Nasopharynx (can decrease risk of distant Mets, improved organ preservation)

Consider if delay in definitive chemorads and patient has upper airway obstruction/dental abscess

Question 7

AE of Cisplatin

Answer 7

Hearing loss, renal failure, peripheral neuropathy, electrolytes, GI

Question 8

AE of carboplatin

Answer 8

Electrolyte abnormalities, myelosuppression

Question 9

AE of 5-FU

Answer 9

Mucositis, hand-foot syndrome, photosensitivity, maculopapular rash

Question 10

AE of Paclitaxel

Answer 10

P neuro, arthralgia, myalgia

Question 11

AE of Docetaxel

Answer 11

P neuro, edema, asthenia

Question 12

Cetuximab AE

Answer 12

acneiform rash, dermatitis, hypomagnesemia, neutropenia

Question 13

Which early stage H/N tumors should be treated with RT? Which should still get surgery?

Answer 13

RT (if T1-2, N0-1): tongue, tonsil, larynx, hypopharynx, can be considered RT candidates. Nasopharynx uses RT regardless of stage

No RT: salivary glands, FOM. Use surgery regardless of how early stage it is

Question 14

When to add concurrent chemo to radiation for initial Tx of H/N cancers

Answer 14

T3-4, N2-3

Question 15

When to offer adjuvant RT/chemo

Answer 15

margin positive, T3-4, multiple/bulky positive nodes, ECS, PNI, LVI, nodal disease in IV/V, oral cavity depth of invasion >2mm or close margins, recurrent dz treated with salvage surgery

Question 16

When to add concurrent chemo to RT after surgical resection?

Answer 16

positive margins, extracapsular spread/extension

Question 17

When to add adjuvant RT for salivary tumors

Answer 17

close/pos marg, pT3-4, intermediate/high grade, adenoid cystic, bone invvasion, PNI, PVI, node positive

Question 18

When to start adjuvant RT

Answer 18

4-6 weeks after (need healing, but H/N cancers repopulate quickly)
Complete both surgery and ratiation within 13 weeks

Question 19

When to use Rads for skin cancer

Answer 19

Huge tumor - morbid surgery
cosmetic
nonsurgical candidates

Question 20

When to use adjuvant RT +/- chemo for skin cancer

Answer 20

PNI, pos margin, parotid invasion, ear primary with depth invasion >2mm, Clark’s level IV+, poor diff

Question 21

When to radiate nodes for skin cancer

Answer 21

> 3 + nodes, ECS, >4cm, deep invasion, invade underlying structures, cancer of ear esp preauricular

Question 22

Timing of AE of H/N radiation

Answer 22

Acute: Weeks 2-3, resolve 4-6 weeks after completion

Question 23

AE of H/N Rads

Answer 23

Fatigue
Skin rxn
Mucositis
Xerostomia
Hoarse, otitis media, dry eyes, conjunctivitis, keratitis, sinonasal congestion, epistaxis

Question 24

How to treat Rads AE fatigue, skin rxn, xerostoma

Answer 24

Fatigue: exercise, antidepressant
Skin: Moisturizer (non-perfumed), humectant
Xerostomia: water/baking soda/salt/peroxide rinse, biotin, pilocarpine, amifostene (prophy), hygiene

Question 25

How to treat mucositis/dysphagia/odynophagia

Answer 25

diet, manuka honey, lidocaine, benadryl, antacids, NSAIDs, narcotics, sucralfate, steroids, hydration/nutrition

Question 26

Long term RT complications

Answer 26

xerostomia, skin, hypothyroid, ORN, bone exposure, laryngeal edema, esophageal stenosis, vision/hearing, trismus, secondary cancers

Question 27

Stereotactic Body Radiotherapy

Answer 27

Good for re-irradiation

Delivery high dose to areas of relapse, spare normal tissues