Head & Neck Flashcards
Poor prognostic factors in papillary thyroid cancer
1) Old (age over 55)
2) gross soft tissue invasion (extrathyroidal) of the tumor into the airway, nerves, or major vessels of the neck
3) extensive microscopic vascular invasion
4) inappropriately elevated serum thyroglobulin after initial therapy
Histologic subtypes of papillary thyroid cancer with worse prognosis
tall cell, insular, and hobnail variants
Biomarker for recurrence in papillary thyroid cancer
Serum thyroglobulin
Biomarker for recurrence in papillary thyroid cancer
Serum thyroglobulin
Genetic syndromes associated with increased risk for head and neck
- fanconi anemia
- dyskeratosis congenita
oral cavity in head and neck anatomic compartment
- buccal mucosa, floor of mouth, anterior 2/3s of tongue, alveolar ridge, hard palate
oropharyngeal in head and neck anatomic compartment
- tongue base
- tonsils
- inferior soft palate
- posterior phalanx
Localized oral cavity management
Upfront surgery
Adjuvant in head and neck generally speaking
Typically chemoradiation
When surgery is preferred over CRT in laryngeal
1) Poor laryngeal function
2) At risk of chronic aspiration (ENT/rad onc will decide)
3) *T4
Indications for adjuvant chemoradiation in head and neck
1) Positive margins
2) ECE
Stage I nasopharyngeal management
- XRT alone
Systemic therapy for induction chemotherapy in locally advanced nasopharyngeal
- cisplatin/gemcitabine
*now phase III data for cisplatin/gemcitabine/sintilimab
Systemic therapy for metastatic nasopharyngeal
Toripalimab + gemcitabine 1000 mg/m2/cisplatin 80 mg/m2
1) First line systemic therapy for metastatic head and neck 2) based on PD-L1
Independent of PD-L1 (Dr. Walsh) AND liver mets OR substantial burden of disease, carbo (AUC5)/taxol (175)/pembro (PREFERRED over carbo/5-Fu, better tolerated and doesn’t involve continuous infusion. Robust Phase II data. KEYNOTE-B10 – ORR 48%, PFS 6 months but different dosing AUC 5 and taxol 175 (Gyn onc dosing) (can also do weekly carbo/taxol per Phase II)
IF CPS >20% AND no liver mets or rapidly progressive disease, pembrolizumab monotherapy (ORR ~20%, Hasn’t been compared to platinum/5-fu/pembro, only to extreme regimen in Keynote-048, most experts are starting with pembro and salvaging with chemo)
IF CPS < 1, carbo/taxol/pembro
IF immunotherapy ineligible, cetuximab + carbo/taxol
IF taxol contraindication or hypersensitivity, Carboplatin/5-Fu/pembrolizumab (BOARDS MAY SAY THIS IS SOC)