General + PORT

Question 1

When should LN Lvl IV be included in the oral cavity/tongue cancer treatment volume?

Answer 1

• Include IV if:
  – Anterior tongue tumor
  – Any oral cavity tumor with extension to the oropharynx
  — Anterior tonsillar pillar
  — Tonsillar fossae
  — Base of tongue
  – N1 tumor with involvement of level III
• Otherwise, Lvl IV can be omitted

Question 2

What is unique about the LN involvement for oral tongue cancers?

Answer 2

• High rate of occult LN metastases, even in a node-negative tongue

Question 3

Which muscle, when involved by tumor, can cause trismus?

Answer 3

• Lateral pterygoid
  – Opens up the jaw
  – involvement can lead to lock jaw

Question 4

What T stage is a tumor of the NPX involving the pterygoid plates?

Answer 4

T3

Question 5

What T stage is a H&N tumor (except NPX) involving the pterygoid plates?

Answer 5

T4

Question 6

What is an essential route of spread for adenoid cystic carcinomas of the H&N?

Answer 6

• Perineural spread

Question 7

When should you chase cranial nerves to the skull base for H&N cancers?

Answer 7

• Pathologically involved
• Involvement suggested by clinical sx

Question 8

Which orbital foramina are associated with which branches of the CN V?

Answer 8

• Standing Room Only (SRO)
  – V1: Superior Orbital Fissure
  – V2: Rotundum
  – V3: Ovale

Question 9

Is RT used for the benign pleomorphic adenomas of the parotid gland?

Answer 9

• Initial management is usually surgical resection
• Upon recurrence, salvage surgery may be possible but may end up sacrificing the facial nerve
  – If these recurrences have high-risk features, such as multinodular disease, tumor spillage during resection, +margins → adjuvant RT to 50-60 Gy may be considered (LC rate > 90%)

Question 10

Which risk factors warrant the inclusion of concurrent CHT to RT in the post-op management of H&N SCCs?

Answer 10

• +margins
• ENE

Pooled analysis of EROG 95-01 + EORTC 22931

Question 11

Are there other indications for chemotherapy in the post-op setting for H&N cancer besides +margins and ENE?

Answer 11

• Possibly, such as:
  – close margins
  – LVI
  – PNI
• They are being investigated in RTOG 0920

Question 12

What were the findings of the Tata Memorial (Noronha et al., JCO 2018) trial comparing doses of concurrent cisplatin for locally advanced H&N cancers?

Answer 12

Cisplatin 30 mg/m² weekly vs. 100 mg/m² q3 weeks
- 2-yr LRC: 58.5% vs. 73.1% (P = .014)
– Abs difference of 14.6%
- Tox ≥ Gr 3: 71.6% vs. 84.6% (P = .006)