Head and Neck Flashcards
Boundaries of retropharyngeal and retrostyloid?
VIIa (retropharyngeal): upper edge of C1/hard palate to cranial hyoid
VIIb (retrostyloid): base of skull to lateral process of C1
Where does HN level II turn to level III?
Caudal hyoid body
When could unilateral RT for OC be considered?
> 1cm from midline and buccal, RMT, and superficial lateral oral tongue.
What makes T3 and T4 in oral cancer?
T3: 2-4cm and >10cm doi or >=4cm and DOI <10cm
T4a: >4cm and >10mm, invasion of mandible, skin, maxilla
T4b: Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery.
For HN re-irradiation what dose do you want to keep the cord below?
Cumulative biologically effective dose (BED) of 120 Gy
OC LC and OS outcomes?
LC 80/70/50/20% for T1/2/3/4.
N0 ~80% and N+ 5yr OS more in the 50-60% range.
Low, intermediate, and high-risk HPV+ groups with OS?
Low: <10 pack yrs N0-N2a, OS 90%+
Intermediate: N2b-N3, HPV- and T2-3 and <10 pack years; OS 60-80%
High risk: HPV- and T4 or >10 pack years and HPV-; OS 40-60%.
If using induction chemo in HN, what is it?
- Docetaxel/cisplatin/5-FU
What LN levels do you cover if larynx with N+?
II-IVa, and VI if transglottic or subglottic extension.
When do you cover the stoma and to what dose?
Cover the stoma to 60Gy if emergent trach or subglottic extension.
What do you cover in post-laryngectomy case?
CTV 60: resection bed+neopharynx+nodal stations+
CTV 54: entire stoma and uninvolved LNs
T staging for salivary tumors?
T1 Tumor 2 cm or smaller in greatest dimension without extraparenchymal extension
T2 Tumor larger than 2 cm but not larger than 4 cm in greatest dimension without extraparenchymal extension
T3 Tumor larger than 4 cm and/or tumor having extraparenchymal extension
T4a Tumor invades skin, mandible, ear canal, and/or facial nerve
T4bTumor invades skull base and/or pterygoid plates and/or encases carotid artery
What special LN coverage consideration for hypopharynx?
1) always cover RP nodes
2) is piriform sinux apex involvment, cricoid, or esophageal involvement then cover level VI.
What induction and adjuvant chemo for NPX cancer?
Induction gem/cis and adjuvant cis/5-FU
What are the risk volumes covered in NPX?
69/96/59.4/54.12 in 33 fractions or 70/63/56
High: gross disease +5cm
Medium: NPX, post 1/4 nasal cavity, sphenoid 1/2 if T1-2 and whole if T3-T4, ovale/rotundum/lacerum, parapharyngeal space, PPF, clivs 1/3 or whole, any LN stations that are positive, RP/RS nodal.
Low: 1b optional,II-V bilateral.
Staging for Sinonasal sinus tumor?
What are the most common benign salivary gland tumors? What about malignant?
Pleomorphic adenoma, warthin’s tumor, oncocytoma, basal cell adenoma, myoepithelioma.
Muco-epidermoid caricnoma, acicin cell caricnoma, adenocaricnoma NOS, (G3) carcinoma ex-pleomorphic adenoma, adenoid cystic carcinoma (G3), salivary duct carcinoma (G3).
Merkel Cell Staging?
T1: 0-2cm
T2: >2-5cm
T3: >5cm
T4: bone, cartiledge, fascia, muscle
N1: +LN
1a (sn): SLNB
1a: +LN after dissection
1b: clinically or radiographic and microscopically positive.
N2: In-transit met
N3: both
Indications for post-op RT for cutaneous SCC or BCC?
T3 (PNI or >6mm depth), T4 (bone or skull base), recurrent after margin neg resection, desmoplastic, adenoid, adenosquamous, metaplastic tumors, R1 or R2 when further surgery is not possible.
Neck dissection types?
What’s in Magic Mouthwash. What else for mucotitis?
Diphenhydramine, generic Maalox, and lidocaine
Doxipine rinse for mouthwash.
Mugard?
Best prognosis NPX type? NPX 5yr OS?
Nonkeratizing, undifferentiated, EBV associated: WHO III
Expected 5 yr OS:
Stage I (T1N0): 80-90%
Stage II (T2 or N1): 70-80%
Stage III (T3 or N2): 50-70%
Stage IVA (T4 or N3): 40-50%
Common salivary gland tumors?
Pleomorphic adenoma, mucoepidermoid ca, acinic cell (2nd most common), adenoid cystic carcinoma, adenocarcinoma (commonly goes to nodes).
Main thyroid cancers?
Follicular, papillary (both RAI candidates), medullary, and anaplastic.
