Head and Neck

Question 1

Vocal cord paralysis in the setting of a primary tumor of the larynx or hypopharynx indicates which clinical stage

Answer 1

Vocal cord paralysis in the setting of a primary tumor of the larynx or hypopharynx indicates a stage of no less than T3.

Question 2

Primary Criteria for Unresectable Tumors (4)

Answer 2

Primary criteria for unresectability include:
- base-of-skull involvement
- fixation to the prevertebral fascia
- carotid encasement
- involvement of the pterygoid musculature

Question 3

Hypopharynx lymph node size staging (N1, N2, N3)

Answer 3

N1 < 3 cm
N2 > 3 cm
N3 > 6 cm or contralateral LN metastasis

Question 4

Preferred Induction Chemotherapy Regimen for Laryngeal Carcinoma

Answer 4

When induction chemotherapy is incorporated, TPF is the preferred regimen and is associated with improved survival when compared with PF.

Question 5

First Line Treatment for Metastatic or Recurrent, Non-nasopharyngeal Head and Neck cancer

Answer 5

a. First Line Systemic Therapy:
- Pembrolizumab + cisplatin/carboplatin + 5-FU
- Cetuximab + cisplatin or carboplatin + 5-FU
b. If CPS ≥1: Pembrolizumab monotherapy
c. Progression after platinum based chemotherapy: Nivolumab mono therapy

Question 6

Preferred systemic chemotherapy regimen for thymoma when given with and without radiation

Answer 6

a. Preferred systemic chemotherapy regimen for Thymoma: Cisplatin, Doxorubicin, Cyclophosphamide.

b. If chemotherapy is given with Radiation for patients with Thymoma: Cisplatin + Etoposide

Question 7

Preferred chemotherapy regimen for patients with thymic carcinoma

Answer 7

Carboplatin/Paclitaxel.

Question 8

Choices of adjuvant therapies in treatment of mucosal melanoma

Answer 8

Adjuvant systemic therapy is considered for patients with mucosal melanoma, one can consider offering Nivolumab or Cisplatin/Temozolomide

Question 9

Oropharyngeal cancer locations (4) and treatment of T1-2 N0 HPV negative disease

Answer 9

Locations:
a. base of the tongue
b. tonsil
c. posterior pharyngeal wall
d. soft palate

Primary Treatment for T1-2, N0-1 tumor that is HPV-:
a. Definitive RT
b. Resection of the primary with an ipsilateral or bilateral neck dissection

Question 10

Which are the indications for use of pembrolizumab and nivolumab in treatment of metastatic head and neck squamous cell carcinomas?

Answer 10

• Pembrolizumab, either as monotherapy (must be PD-L1 positive by CPS) or in combination with platinum doublet (any PD-L1 status) is recommended for patients with recurrent/metastatic laryngeal cancer
• If not previously exposed to a checkpoint inhibitor in the first line setting, nivolumab is recommended in the second line setting.
  -Either nivolumab or pembrolizumab are therefore appropriate systemic options regardless of PD-L1 status in patients with platinum-refractory HNSCC

Question 11

First-line treatment of recurrent or metastatic NPC

Answer 11

Pembrolizumab or nivolumab may be offered in combination with GC for first-line treatment of recurrent or metastatic NPC

Question 12

First Line Treatment of Recurrent or Metastatic H&N Cancer based upon CPS score

Answer 12

If CPS > 1:
Pembrolizumab +/- 5-FU + Cisplatin

If CPS > 1:
- Pembrolizumab +/- 5-FU + Cisplatin OR
- Cetuximab and chemotherapy can be considered

Question 13

Induction chemotherapy can be considered in patients which stage of hypopharyngeal cancer and what is recommended treatment option based upon response category (CR, SD/PR, Less than PR)

Answer 13

Induction therapy for T2-3 any N or T1 N+ disease
If CR: definitive treatment with RT
If PR/SD: Concurrent chemoRT or surgery
If < PR: surgery or concurrent chemoRT

Chemotherapy Regimens with RT:
* High-dose cisplatin
* Carboplatin/infusional 5-FU
* Carboplatin/paclitaxel
* Docetaxel (if cisplatin ineligible)
* Cetuximab (category 2B)
* Cisplatin/infusional 5-FU or Cisplatin/paclitaxel

Question 14

Standard of Care Treatments for the following sites of disease:

Answer 14