Head and Neck Flashcards
Which RTOG showed that pts with HPV did better?
HPV infection with p16+ status gives a better outcome. This was form RTOG 0129 and the 3 yr OS was 82.9% vs 57.1%
Which of the following is NOT part of the larynx? - True vocal cord - Pyriform sinus - Aryepiglottic fold - Suprahyoid epiglottis
- Pyriform sinus is part of the hypopharynx
What are the 3 subsites for larynx?
Supraglottic, glottic, subglottic
Name 5 structures that make up the supraglottic larynx
AE (Aryepiglottic) folds, arytenoids, false cords, suprahyoid epiglottis, infrahyoid epiglottis
Name 3 structures that make up the glottic larynx
true vocal cords, anterior and posterior commissures
What is the extension of the subglottic larynx?
Extends inferiorly from the glottis to the lower margin of the cricoid cartilage.
What is the anatomical name?
Left foramen ovale
What are the 5 branches of facial nerve?
Temporal
Zygomatic
Buccal
Marginal Mandibular
Cervical
6 weeks, 11-12 weeks
If patients are delayed more than 6 weeks following surgery, what can be considered?
accelerated fractionation
The study included stage III/IV (T2, T3, and early T4) squamous cell carcinoma of the glottis or supraglottic larynx
Intergroup trial (Adelstein et al. JCO 2003) showing benefit to 70 Gy + cisplatin vs 70 Gy alone
What are the 5 subsites of supraglottic larynx?
False cords = ventricular bands
Arytenoids
Aryepiglottic folds
Suprahyoid epiglottis
Infrahyoid epiglottis
Define T1 supraglottic
T1 is the tumor limited to 1 subsite of supraglottis with normal vocal mobility
Define T2 supraglottic
T2 is the tumor invading mucosa of more than 1 adjacent subsite of supraglottis, or glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx
Define T3 supraglottic
T3 is the tumor limited to larynx with vocal cord fixation and/or invades any of the following:
Postcricoid area, pre-epiglottic space, paraglottic space, and/or inner cortex of thyroid cartilage
Define T4a supraglottic
T4a is moderately advanced local disease. This is the tumor invading through the (to the outer cortex of thyroid cartilage) thyroid cartilage and/or invades tissues beyond the larynx (trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscle (Infrahyoid muscles), thyroid, or esophagus)
Define T4b supraglotic
T4b is very advanced local disease. Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structure
Describe the RTOG 0129 (Ang et al. NEJM 2010) study and the result of the study too.
- A phase III randomized trial with an original intention to compare accelerated radiation therapy with concurrent chemo vs. conventional fractionation RT with concurrence chemo.
- Randomized OC, OP, hypopharynx, larynx.
- Results at 3 yrs showed no difference in OS, LRF or toxicity (feeding tube rates 12-15% the same)
- Able to eliminate 1 cycle of chemo with accelerated course
What are the two main post-op studies in Head and Neck and each conclusions form the two studies?
RTOG 95-01 → 2 yr outcome showed improved LRC (72 → 82%) with chemo but no difference in OS
EORTC 22931 → 5 yrs outcome showed improved PFS, LRC, OS (40 → 53%)
Per RTOG 0129, low, intermediate, and high risk of death on the basis of what 4 factors?
- HPV status
- Number of pack yrs smoking
- T-stage
- N-stage
Per RTOG 0129, what is low risk?
- HPV positive, =< 10 pack yrs of smoking
- HPV positive, > 10 pack yrs of smoking, and N0-2a disease
Per RTOG 0129, what is intermediate risk?
- HPV positive tumor, > 10 pack yrs, and N2b-3 disease
- HPV positive tumor, =< 10 pack yrs, and T2-3 tumor
Per RTOG 0129, what is high risk?
- HPV negative tumor, =< 10 pack yrs, and T4 tumor
- HPV negative tumor, and > 10 pack yrs
