H&N Flashcards
Oropharynx Dose
Post op: 60,66 & 70 (200cGy)
Pre-op: 30-50Gy
Nasopharynx Dose
70Gy to primary tumour
50-60 to elective neck
Hypopharynx Dose
Commonly delivered with concurrent chemo
Low-high risk
56-63-70
Post-op: 60/30
LN-50-54
Larynx dose
EBRT Glottic Carcinoma
T1: 66/33
T2: 70/35
if concurrent chemo: 70Gy in 200
RT alone: 70-72 (200cGy)
Oropharynx Pathology & Lymphatics & distant mets
SCC
LN drainage: MC location-ipsilateral level 2 neck
Base of tongue: jugulodigastric nodes
Mets to ipsilateral level 2 neck
Nasopharynx Pathology & lymphatics & distant mets
Non-keratinizing cancer
Retropharyngeal & level 2 neck nodes then node of Rouviere
Bone lung luver
40% recurrence rate
Hypopharynx Pathology & lymphatics & distant mets
SCC
50% will have positive cervical nodes
60-80% will have nodal involvement
level II & III LN most commonly involved
Lung
Cancers lateral wall and pyriform sinus can invade thyroid
Larynx Pathology & lymphatics & distant mets
SCC
Essentially no lymphatics in the glottic region. if extended to supra or subglottic it can spread to jugulodigastric nodes
Lung
Oral Cavity Lymphatics
- Lip
- Floor of mouth
- 2/3 ant tongue
- Buccal mucosa
- Hard plate
- Retromolar Trigone
- Upper Lip: Submandibular (more likely to be involved)
Lower lip: Submandibular, Submental & jugulodigastric - Submandibular jugulodigastric & Submental
3.Submental, submandibular and jugulodigastric - Submandibular & jugulodigastric
- none
- same as buccal mucosa
Dose Oral Cavity
Lip: 100-200KeV, 6-9MeV w/bolus or 70Gy
2/3 ant tongue: 60-70
Post-op
Low-high risk–> 50-60-66
RT
Low-high risk–> 50-60-70
PTV includes CTV+3-5mm for set up error
Salivary gland Pathology & lymphatics
Mucoepidermoid
The risk of LN involvement increases with increasing T stage, size and grade
Paranasal sinus Pathology & lymphatics & distant mets & prognostic indicator
SCC
Maxillary sinus has limited lymphatics, once tumour extends–>ipsilateral jugulodigastric and submandibular
Ohngren’s line
- classifying maxillary sinus
- poor prognosis
Oropharynx S&S +MC site
Tonsillar Fossa (MC site) -Sore throat & odynophagia
Base of tongue
-localized pain & painless lump in neck
Soft palate
-impaired speech
Nasopharynx S&S +MC site
Asymptomatic initially
–>nasal stuffiness, epitaxies, ear pain
Fossa of Rosenmuller (MC site)
Horner’s syndrome
–>drooping eyelid, decrease pupil size
Hypopharynx S&S +MC site
Sore throat & odynophagia
Piriform sinus (MC site)
Larynx S&S +MC site
Hoarseness and sore throat
Glottic region (True vocal cords)
Epi/Eti of 1. Oro, 2. naso, 3. hypo and 4.larynx
- HPV 16+–> better prognosis & tobacco + alcohol
- HPV (Epstein barr visus)- NOT related to smoking
- Smoking and alcohol
- HPV, acid reflux & Smoking (MC H&N cancer)
Salivary Gland S&S + Epi/Eti
Painless (parotid) mass and rapid growth
1:1 male to female ratio
Paranasal Sinus S&S + Epi/Eti +MC site
Asymptomatic
long sinusitis, nasal obstruction
*Maxillary sinus MC Site
Rare
Chronic irritants such as asbestos
Vallecula
A depression just behind the root of tongue
Spit trap
saliva is held here to prevent the initiation of swallowing reflux
Oropharynx tx fields
Ant: 2cm ant to tumour
Post: behind spinous process
Sup: 2cm sup of soft palate (entire jugular chain and above C1)
Inf: Hyoid bone C3
Ant matches sup border of lats
inf: sternal notch
lat: includes s/c nodes and blocking head of humorous
Nasopharynx tx fields
POP lat fields
Sup: lateral canthus to above zygomatic arch
inf: level of thyroid to protect larynx (bottom of C4)
Ant: include post 1/3 of maxillary sinus and nasal cavity
post: behind the vert bodies
s/c field same as oro
Hypopharynx tx fields
Sup: inf border of mandible and mastoid process to base of skull
inf: below cricoid (C6)
ant: front of thyroid
post: spinous process
Larynx tx fields
Glottic T1-2 N0
Sup: top of thyroid
Inf: below cricoid (C6)
Ant; 1cm flash over skin surface
Post: ant of vert body
*If starting to invade LN
Sup: extends 2-3cm
Post: mid vertebrae
Salivary gland tx field
Sup: zygomatic arch
Inf: top of thyroid
Ant: ant border of masseter muscle
Post: behind mastoid muscle
