Head & Neck

Question 1

What is the most common form of radiation therapy?

Answer 1

Photon

Question 2

An electron produces ___ penetration and is ideal radiation therapy for the ___. (structure)

Answer 2

An electron produces superficial penetration and is ideal radiation therapy for the skin.

Question 3

A neutron is a ___-energy particle and is highly ___.

Neutrons are a form of radiation used for ___ malignancies.

Answer 3

A neutron is a high-energy particle and is highly toxic.

Neutrons are a form of radiation used for salivary gland malignancies.

Question 4

A proton is a __-energy particle w/a sharp peak in delivered dose, followed by a rapid falloff beyond the target (Bragg peak).

Protons are used for ___ malignancies, where dose to critical adjacent structures must be minimized.

Answer 4

A proton is a low-energy particle w/a sharp peak in delivered dose, followed by a rapid falloff beyond the target (Bragg peak).

Protons are used for skull-base malignancies, where the dose to critical adjacent structures must be minimized.

Question 5

A Carbon ion is a ___-energy particle with a sharp Bragg peak (delivered target dose).

Answer 5

A Carbon ion is a high-energy particle with a sharp Bragg peak (delivered target dose).

Question 6

Radiation Therapy is delivered via what forms (1-4)?

Answer 6

1. Conventional radiation
2. Intensity-modulated radiation therapy (IMRT)
3. Brachytherapy
4. Stereotactic body radiation therapy (SBRT)

Question 7

The ideal radiation dose for Intensity-Modulated Radiation Therapy (IMRT) is based on ___.

Answer 7

Imaging.
(A computer algorithm is applied to achieve the ideal distribution)

Question 8

Intensity-Modulated Radiation Therapy (IMRT) offers precise control, by ___.

Answer 8

Multiple small beamlets converging on a target

Question 9

What form of Radiation Therapy is best to dose the following critical structures (salivary glands, pharyngeal constrictors, temporal lobe, optic nerve, cochlea, spinal cord)?

Answer 9

Intensity-Modulated Radiation Therapy (IMRT)

Question 10

Brachytherapy works by Radioisotopes applied to tumor bed, that create ___, and have a ___ dose falloff of radiation.

Answer 10

Brachytherapy works by Radioisotopes applied to tumor bed, that create permanent implants (beads) or interstitial catheters, and have a rapid dose falloff of radiation.

Question 11

What form of radiation therapy is best to treat the following?
- Lip cancer
- Nasopharyngeal recurrence
- BOT recurrence

Answer 11

Brachytherapy

Question 12

The indications for Post-op Radiotherapy are:
1. _____
2. Multiple positive nodes
3. Positive surgical margins
4. Perineural invasion

Answer 12

The indications for Post-Op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes
3. Positive surgical margins
4. Perineural invasion

Question 13

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. _____
3. Positive surgical margins
4. Perineural invasion

Answer 13

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes: (w/o ENE radiation alone); (w/ENE, concurrent chemorads)
3. Positive surgical margins
4. Perineural invasion

Question 14

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes
3. _____
4. Perineural invasion

Answer 14

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes
3. Positive surgical margins -> (may undergo reresection or concurrent chemorads if re-resection is not possible)
4. Perineural invasion

Question 15

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes
3. Positive surgical margins
4. _____

Answer 15

The indications for Post-op Radiotherapy are:
1. Advanced stage (pT3, pT4)
2. Multiple positive nodes
3. Positive surgical margins
4. Perineural invasion

Question 16

What is the timing of Primary Radiation Therapy?

Answer 16

2 weeks after necessary dental extractions

Question 17

What is the timing of Adjuvant Radiation Therapy?

Answer 17

Within 4-6 weeks after surgery

Question 18

Delays in initiation of post-op adjuvant radiation are associated with decreased ___ and ___.

Answer 18

Delays in initiation of post-op adjuvant radiation are associated with decreased locoregional control and overall survival.

Question 19

Conventional Radiation fractionation is performed ___ (frequency)

Answer 19

5 days/week x 7 weeks

Question 20

Radiation Hyperfractionation is a ___ total dose.

Answer 20

Decreased dose/fraction, increased # of fractions, thus larger total dose.

Question 21

An Accelerated fractionation is a ___ total dose and ___ treatment duration.

Answer 21

Conventional dose/fraction, increased # of fractions, thus a similar total dose and decreased treatment duration

Question 22

Hypofraction is a ___ total dose and ___ treatment duration

Answer 22

Smaller total dose and decreased treatment duration

Question 23

Which form of radiation therapy is least likely to cause ORN?

Answer 23

Intensity-Modulated Radiation Therapy (IMRT)

(B/c there is minimization of the dose to critical structures)

Question 24

ORN of the mandible is most likely to occur above what radiation therapy dose?

Answer 24

Radiation dose >60 Gy.

(Remember, 1 Gy = 1 Joule of energy deposited/kg;
Radiation-absorbed dose (rada): 100 rad = 1 Gy)

Question 25

What area of the mandible is more likely to be affected by ORN?

Answer 25

Posterior mandible.

Question 26

What secondary malignancy are patients most at risk for from radiation therapy?

Answer 26

Sarcomas