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RO Clinical Boards > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What is isotope for RAI

A

I-131

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2
Q

How long is I-131 in saliva

A

7 days

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3
Q

What is primary mode of exretion for RAI

A

urine, max in first 48h

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4
Q

What group is absolute contraindication to RAI

A

pregnant

nursing - I131 is in breast milk

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5
Q

How to contour mandible - which window, include teeth or no?

A

EXCLUDE teeth

bone window

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6
Q

Sup/inf landmarks for level II

A

skull base to hyoid

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7
Q

What separates IIA from IIB

A

internal jugular vein

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8
Q

Sup/inf landmarks for level III

A

hyoid to cricoid

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9
Q

Sup/inf landmarks for level IVa

A

cricoid to 2 cm above sternoclav joint

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10
Q

PNI vs. PNS

A

PNI is microscopic and cannot be seen on imaging

PNS is macroscopic and can be seen on imaging

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11
Q

What histologies associated with PNS

A

SCC
Desmoplastic melanoma
ACC

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12
Q

What nerve provides sensory input to anterior 2/3 tongue

A

V (lingual nerve)

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13
Q

What nerve provides taste to anterior 2/3 tongue

A

VII chorda tympani

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14
Q

What nerve provides motor function to tongue

A

XII

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15
Q

What nerve provides taste to posterior 1/3 tongue

A

IX glossopharyngeus

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16
Q

What nerve provides sensory to posterior 1/3 tongue

A

IX glosso

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17
Q

Referred ear pain from orophaynx comes from

A

IX (Jacobson’s nerve)

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18
Q

Referred ear pain from layrnx comes from

A

X (Arnold’s nerve)

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19
Q

What are general risk factors postop

A 
Primary site - oral cavity
margin status
PNI
Number/location of +nodes
ECE
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20
Q

If patient has ECE or +margin, recommended PORT dose

A

60-66 Gy with chemo (HD cis)

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21
Q

EORTC 22931 research question

A

Benefit to adding chemotherapy to postop RT

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22
Q

EORTC 22931 patient population

A

pT3 or pT4 any nodal stage except T3 larynx
pT1/2 N2-3
Any ENE/+margin/PNI/vascular embolism

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23
Q

Dose of RT given EORTC 22931

A

66Gy

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24
Q

Dose of chemo given EORTC 22931

A

cisplatin 100 mg/m2

Day 1, 22, 43

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25
EORTC 22931 results
CRT improved DFS, OS, LRC
26
Increase in oral cavity cancers in what demographic group
young, non-smoking females
27
Where is the division between oral cavity and oropharynx
circumvallate papillae
28
What subsite is retromolar trigone
oral cavity
29
T1 oral cavity
<2 cm, DOI < 5mm
30
T2 oral cavity
<2 cm, DOI 5-10 mm | 2-4 cm, DOI <10 mm
31
T3 oral cavity
2-4 cm, DOI > 10mm | >4 cm, DOI < 10
32
T4a oral cavity
Tumor > 4 cm with DOI > 10 | Invades cortical bone
33
N1 oral cavity
single ipsi LN, <3 cm, no ENE
34
N1 is stage
III | unless pT4a --> IVA
35
N2 is stage
IVA
36
N3 is stage
IVB
37
At what DOI should a neck dissection be considered for a T1N0 tumor
2-4 mm (20% risk of occult neck disease)
38
Under what situations for oral cavity to consider adjuvant CRT
+ENE | +margins
39
Under what situations for oral cavity to consider adjuvant RT
``` T3/T4 PNI close margins LVI 2+ LN ```
40
For what structures to cover level 1A
end of tongue | middle lip
41
PORT dose to resected areas
60 Gy
42
PORT dose to areas of ENE or positive margins
66 Gy
43
PORT dose to elective nodal regions
54 Gy
44
Per the D'Cruz paper- the likelihood of N+ correlated to
depth of invasion
45
For cT1-2N0, N+ with 3 mm DOI was
6%
46
For cT1-2N0, N+ with 4 mm DOI was
17%
47
They found what benefit to elective neck dissection vs. therapeutic
OS and DFS | regardless of whether or not postop RT was given
48
Per the D'Cruz paper, what was the rate of N+ disease in the elective dissected neck for cT1-2N0 OC
30%
49
what % of OPX cases present with nodes
70%
50
HPV+ OPX T1
< 2 cm
51
HPV+ OPX T2
2-4
52
HPV+ OPX T3
>4 cm or extension to lingual epiglottis
53
HPV+ OPX T4
any size invading adjacent structures
54
HPV+ OPX pN1
= 4 LN
55
HPV+ OPX pN2
> 4 LN
56
HPV+ OPX cN1
one or more ipsi LN, all < 6 cm
57
HPV+ OPX cN2
contralateral or bilateral LN, all <6cm
58
HPV+ OPX cN3
any LN > 6 cm
59
General cN1
single ipsi LN < 3 cm, no ENE
60
General cN2a
single ipsi LN 3-6 cm, no ENE
61
General cN2b
multiple ipsi LN, all <6 cm, no ENE
62
General cN2c
contralateral or bilateral LN, all <6cm, no ENE
63
General cN3a
Any node >6cm, no ENE
64
General cN3b
Clinically over ENE
65
For which OPX cases could you consider definitive RT alone
T2N1 or less
66
Reasons for definitive chemoRT for OPX
Multiple nodes T3/T4 Single node > 3 cm (N2 disease) Clinical evidence of ECE
67
RTOG 1016 design
HPV+ OPX getting definitive CRT randomized to: - -cis+70 Gy - -cetux+70 Gy
68
RTOG 1016 results
cetuximab had significantly inferior OS and PFS
69
How was RT given on RTOG 1016
70 Gy, accelerated 6 fx per week, one day BID with at least 6 hrs between sessions
70
MACH meta analysis question
ChemoRT vs. RT for locally advanced HNSCC
71
MACH-HN results
Absolute OS benefit of CRT 6.5% at 5 years
72
Parotid mean dose goal
<26 Gy
73
Mandible dmax
<70 Gy
74
NPX T1
Confined to NPX +/- OPX or nasal cavity
75
NPX T2
Parapharyngeal extension
76
NPX T3
Bony structures of skull base or paranasal sinus
77
NPX T4
Intracranial extension, CN, hypopharynx, orbit, masticator space
78
NPX N1
unilateral LN < 6 above cricoid | b/l RP nodes ok
79
NPX N2
bilateral cervical nodes <6 cm above cricoid
80
NPX n3
nodes >6 cm | nodes below cricoid
81
Treatment paradigm for locally advanced NPX
chemoradiation --> adjuvant chemo
82
Dose for NPX
70 Gy in 35 fx with concurrent Cis
83
Al-Sarraf regimen
randomized to 70 Gy 70 Gy + HD Cis --> cis/5FU x 3 cycles
84
Al-Sarraf dose of chemo
cis 100 mg/m2 q3w (day 1, 22, 43) then cis 80 mg/m2 5FU (1000 mg/m2) q4w x 3 cycles
85
Al-Sarraf results
Improvement in OS 78% CRT 47% RT
86
T1a larynx
one cord
87
T1b larynx
both cords
88
T2 larynx
extension to supraglottis/subglottis | impaired vocal cord motion
89
T3 larynx
cord fixation or paraglottic space extension | inner cortex of thyroid cartilage
90
T4a larynx
outer cortex of thryoid cartilage esophagus soft tissues of neck thyroid
91
VA larynx population
stage III/IV larynx
92
VA larynx arms
1. Induction cis/5FU x 2 cycles --> if response 3rd cycle --> RT (if no response: laryngectomy +/- RT) 2. Laryngectomy + RT
93
VA larynx results
Equivalent OS
94
What percentage of patients spared larynx on VA larynx trial
2/3
95
What percentage were alive with larynx at 4 years
CRT: 31%
96
MARCH metaanalysis
Looked at role for accelerated fractionation
97
What did it conclude about OS
3.5% improved with accelerated fractionation (mainly due to hyerpfrac)
98
What did it conclude about LRC
6.5% better with altered fractionation

RO Clinical Boards (13 decks)

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