Head and Neck

Question 1

Which RTOG showed that pts with HPV did better?

Answer 1

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%

Question 2

Which of the following is NOT part of the larynx? - True vocal cord - Pyriform sinus - Aryepiglottic fold - Suprahyoid epiglottis

Answer 2

• Pyriform sinus is part of the hypopharynx

Question 3

What are the 3 subsites for larynx?

Answer 3

Supraglottic, glottic, subglottic

Question 4

Name 5 structures that make up the supraglottic larynx

Answer 4

AE (Aryepiglottic) folds, arytenoids, false cords, suprahyoid epiglottis, infrahyoid epiglottis

Question 5

Name 3 structures that make up the glottic larynx

Answer 5

true vocal cords, anterior and posterior commissures

Question 6

What is the extension of the subglottic larynx?

Answer 6

Extends inferiorly from the glottis to the lower margin of the cricoid cartilage.

Question 7

What is the anatomical name?

Answer 7

Left foramen ovale

Question 8

What are the 5 branches of facial nerve?

Answer 8

Temporal

Zygomatic

Buccal

Marginal Mandibular

Cervical

Answer 9

6 weeks, 11-12 weeks

Question 10

If patients are delayed more than 6 weeks following surgery, what can be considered?

Answer 10

accelerated fractionation

Answer 11

The study included stage III/IV (T2, T3, and early T4) squamous cell carcinoma of the glottis or supraglottic larynx

Answer 12

Intergroup trial (Adelstein et al. JCO 2003) showing benefit to 70 Gy + cisplatin vs 70 Gy alone

Question 13

What are the 5 subsites of supraglottic larynx?

Answer 13

False cords = ventricular bands

Arytenoids

Aryepiglottic folds

Suprahyoid epiglottis

Infrahyoid epiglottis

Question 14

Define T1 supraglottic

Answer 14

T1 is the tumor limited to 1 subsite of supraglottis with normal vocal mobility

Question 15

Define T2 supraglottic

Answer 15

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

Question 16

Define T3 supraglottic

Answer 16

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

Question 17

Define T4a supraglottic

Answer 17

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)

Question 18

Define T4b supraglotic

Answer 18

T4b is very advanced local disease. Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structure

Question 19

Describe the RTOG 0129 (Ang et al. NEJM 2010) study and the result of the study too.

Answer 19

• 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

Question 20

What are the two main post-op studies in Head and Neck and each conclusions form the two studies?

Answer 20

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%)

Question 21

Per RTOG 0129, low, intermediate, and high risk of death on the basis of what 4 factors?

Answer 21

1. HPV status
2. Number of pack yrs smoking
3. T-stage
4. N-stage

Question 22

Per RTOG 0129, what is low risk?

Answer 22

1. HPV positive, =< 10 pack yrs of smoking
2. HPV positive, > 10 pack yrs of smoking, and N0-2a disease

Question 23

Per RTOG 0129, what is intermediate risk?

Answer 23

1. HPV positive tumor, > 10 pack yrs, and N2b-3 disease
2. HPV positive tumor, =< 10 pack yrs, and T2-3 tumor

Question 24

Per RTOG 0129, what is high risk?

Answer 24

1. HPV negative tumor, =< 10 pack yrs, and T4 tumor
2. HPV negative tumor, and > 10 pack yrs