H&N Overview on oncologic therapy Flashcards
What defines the ratio of therapy resulting in
therapeutic effect to the amount that results in
toxicity or mortality?
Therapeutic ratio or index
What type of treatment regimen uses only surgery
or radiation therapy for curative intent?
Single-modality treatment. Any approach using more than
one treatment modality is considered multimodality or
combined modality.
What treatment approach uses chemotherapy
and/or radiation therapy before definitive therapy?
Neoadjuvant/Induction therapy
What treatment approach uses chemotherapy and radiation therapy together as the primary treat-
ment modality?
Concurrent (concomitant) therapy
What treatment approach uses radiation therapy
with or without chemotherapy after primary
surgical management?
Adjuvant therapy
What treatment approach uses surgery, chemo-
therapy, and/or radiation for patients with recur-
rent or metastatic disease without the intent to cure? With the intent to cure?
● Palliative therapy
● Salvage therapy
Define the three types of clinical trials.
● Phase I: Defines the maximum tolerated dose or safety of a drug or invasive medical device
● Phase II: Includes more patients than phase I; assesses the efficacy and side effects or toxicity associated with the intervention of interest
● Phase III: Randomized prospective trial comparing the
intervention of interest with the standard of care; at
termination, can be considered for Food and Drug
Administration approval for the intervention of interest.
What tumors are considered by the National
Comprehensive Cancer Network (NCCN, 2011) to
be very advanced and therefore managed with a
unique algorithm regardless of tumor subsite?
T4b, any N, M0 or unresectable nodal disease
The NCCN (2011) recommends either a clinical
trial or standard therapy for patients diagnosed
with very advanced head and neck cancer. How is
standard therapy individualized, and what does it
include?
ECOG performance status (PS):
● PS 0–1: Concurrent chemoradiation therapy with cisplatin
or induction chemotherapy followed by radiation or
chemoradiation therapy
● PS 2: Definitive radiation therapy or concurrent chemo-
radiation therapy
● PS 3: Radiation therapy vs. single-agent chemotherapy vs.
best supportive care
Note: With improvement in surgical management recon-
structive techniques, some authorities suggest that surgical
management should be considered for some T4b tumors.
Patients with recurrent or persistent head and
neck cancer after primary management are
considered by the NCCN (2011) to have very
advanced head and neck cancer. For patients who
do not have distant metastases, what are the
treatment options?
● Locoregional recurrence without prior radiation therapy
○ Resectable: Surgery ± adjuvant therapy (for adverse
risk features) vs. primary chemoradiation therapy
○ Unresectable: individualized based on performance
status to nonsurgical treatment
● Locoregional recurrence or second primary with a history
of prior radiation therapy
○ Resectable: Surgery ± reirradiation ± chemotherapy
○ Unresectable: Reirradiation ± chemotherapy vs. pallia-
tive care
What is the standard therapy recommended by
the NCCN (2011) for metastatic head and neck
cancer?
Based on ECOG performance status (PS):
● PS 0–1: Combination or single agent chemotherapy →
best supportive care
● PS 2: Single-agent chemotherapy or best supportive care
→ best supportive care
● PS 3: Best supportive care
What percentage of patients with locally advanced
head and neck squamous cell carcinoma die from
recurrent locoregional disease within five years of
initial treatment?
30 to 50%
What is the median length of survival for a patient
diagnosed with locally advanced or metastatic
head and neck squamous cell carcinoma?
6 to 9 months
What are the primary goals of palliative therapy?
● Improve quality of life
● Prolong life
What prognostic factors predict poor outcome for
patients with incurable head and neck squamous
cell carcinoma?
● Poor performance status ● Extensive tumor burden ● Malnutrition ● Prior history of extensive definitive therapeutic intervention ● Rapid recurrence or progression
