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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
Q

EORTC 22931 results

A

CRT improved DFS, OS, LRC

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26
Q

Increase in oral cavity cancers in what demographic group

A

young, non-smoking females

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27
Q

Where is the division between oral cavity and oropharynx

A

circumvallate papillae

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28
Q

What subsite is retromolar trigone

A

oral cavity

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29
Q

T1 oral cavity

A

<2 cm, DOI < 5mm

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30
Q

T2 oral cavity

A

<2 cm, DOI 5-10 mm

2-4 cm, DOI <10 mm

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31
Q

T3 oral cavity

A

2-4 cm, DOI > 10mm

>4 cm, DOI < 10

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32
Q

T4a oral cavity

A

Tumor > 4 cm with DOI > 10

Invades cortical bone

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33
Q

N1 oral cavity

A

single ipsi LN, <3 cm, no ENE

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34
Q

N1 is stage

A

III

unless pT4a –> IVA

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35
Q

N2 is stage

A

IVA

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36
Q

N3 is stage

A

IVB

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37
Q

At what DOI should a neck dissection be considered for a T1N0 tumor

A

2-4 mm (20% risk of occult neck disease)

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38
Q

Under what situations for oral cavity to consider adjuvant CRT

A

+ENE

+margins

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39
Q

Under what situations for oral cavity to consider adjuvant RT

A 
T3/T4
PNI
close margins
LVI
2+ LN
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40
Q

For what structures to cover level 1A

A

end of tongue

middle lip

41
Q

PORT dose to resected areas

A

60 Gy

42
Q

PORT dose to areas of ENE or positive margins

A

66 Gy

43
Q

PORT dose to elective nodal regions

A

54 Gy

44
Q

Per the D’Cruz paper- the likelihood of N+ correlated to

A

depth of invasion

45
Q

For cT1-2N0, N+ with 3 mm DOI was

A

6%

46
Q

For cT1-2N0, N+ with 4 mm DOI was

A

17%

47
Q

They found what benefit to elective neck dissection vs. therapeutic

A

OS and DFS

regardless of whether or not postop RT was given

48
Q

Per the D’Cruz paper, what was the rate of N+ disease in the elective dissected neck for cT1-2N0 OC

A

30%

49
Q

what % of OPX cases present with nodes

A

70%

50
Q

HPV+ OPX T1

A

< 2 cm

51
Q

HPV+ OPX T2

A

2-4

52
Q

HPV+ OPX T3

A

> 4 cm or extension to lingual epiglottis

53
Q

HPV+ OPX T4

A

any size invading adjacent structures

54
Q

HPV+ OPX pN1

A

= 4 LN

55
Q

HPV+ OPX pN2

A

> 4 LN

56
Q

HPV+ OPX cN1

A

one or more ipsi LN, all < 6 cm

57
Q

HPV+ OPX cN2

A

contralateral or bilateral LN, all <6cm

58
Q

HPV+ OPX cN3

A

any LN > 6 cm

59
Q

General cN1

A

single ipsi LN < 3 cm, no ENE

60
Q

General cN2a

A

single ipsi LN 3-6 cm, no ENE

61
Q

General cN2b

A

multiple ipsi LN, all <6 cm, no ENE

62
Q

General cN2c

A

contralateral or bilateral LN, all <6cm, no ENE

63
Q

General cN3a

A

Any node >6cm, no ENE

64
Q

General cN3b

A

Clinically over ENE

65
Q

For which OPX cases could you consider definitive RT alone

A

T2N1 or less

66
Q

Reasons for definitive chemoRT for OPX

A

Multiple nodes
T3/T4
Single node > 3 cm (N2 disease)
Clinical evidence of ECE

67
Q

RTOG 1016 design

A

HPV+ OPX getting definitive CRT randomized to:

  • -cis+70 Gy
  • -cetux+70 Gy
68
Q

RTOG 1016 results

A

cetuximab had significantly inferior OS and PFS

69
Q

How was RT given on RTOG 1016

A

70 Gy, accelerated 6 fx per week, one day BID with at least 6 hrs between sessions

70
Q

MACH meta analysis question

A

ChemoRT vs. RT for locally advanced HNSCC

71
Q

MACH-HN results

A

Absolute OS benefit of CRT 6.5% at 5 years

72
Q

Parotid mean dose goal

A

<26 Gy

73
Q

Mandible dmax

A

<70 Gy

74
Q

NPX T1

A

Confined to NPX +/- OPX or nasal cavity

75
Q

NPX T2

A

Parapharyngeal extension

76
Q

NPX T3

A

Bony structures of skull base or paranasal sinus

77
Q

NPX T4

A

Intracranial extension, CN, hypopharynx, orbit, masticator space

78
Q

NPX N1

A

unilateral LN < 6 above cricoid

b/l RP nodes ok

79
Q

NPX N2

A

bilateral cervical nodes <6 cm above cricoid

80
Q

NPX n3

A

nodes >6 cm

nodes below cricoid

81
Q

Treatment paradigm for locally advanced NPX

A

chemoradiation –> adjuvant chemo

82
Q

Dose for NPX

A

70 Gy in 35 fx with concurrent Cis

83
Q

Al-Sarraf regimen

A

randomized to
70 Gy
70 Gy + HD Cis –> cis/5FU x 3 cycles

84
Q

Al-Sarraf dose of chemo

A

cis 100 mg/m2 q3w (day 1, 22, 43)
then
cis 80 mg/m2
5FU (1000 mg/m2) q4w x 3 cycles

85
Q

Al-Sarraf results

A

Improvement in OS
78% CRT
47% RT

86
Q

T1a larynx

A

one cord

87
Q

T1b larynx

A

both cords

88
Q

T2 larynx

A

extension to supraglottis/subglottis

impaired vocal cord motion

89
Q

T3 larynx

A

cord fixation or paraglottic space extension

inner cortex of thyroid cartilage

90
Q

T4a larynx

A

outer cortex of thryoid cartilage
esophagus
soft tissues of neck
thyroid

91
Q

VA larynx population

A

stage III/IV larynx

92
Q

VA larynx arms

A
  1. Induction cis/5FU x 2 cycles –> if response 3rd cycle –> RT (if no response: laryngectomy +/- RT)
  2. Laryngectomy + RT
93
Q

VA larynx results

A

Equivalent OS

94
Q

What percentage of patients spared larynx on VA larynx trial

A

2/3

95
Q

What percentage were alive with larynx at 4 years

A

CRT: 31%

96
Q

MARCH metaanalysis

A

Looked at role for accelerated fractionation

97
Q

What did it conclude about OS

A

3.5% improved with accelerated fractionation (mainly due to hyerpfrac)

98
Q

What did it conclude about LRC

A

6.5% better with altered fractionation

RO Clinical Boards (13 decks)

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