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)
RF for keratinizing vs. non-keratinizing nasopharyngeal
keratinizing = tobacco
non-keratinizing = EBV
Management of locally advanced laryngeal with CR to induction chemotherapy
Definitive radiation
Second line for metastatic head and neck after progression on extreme regimen
Pembro or Nivo
When is p16 testing indicated
- oropharyngeal
NOT oral cavity
Adjuvant management of adenoid cystic carcinoma
- XRT (relatively high rate of local recurrence)
first line for recurrent metastatic differentiated thyroid cancer (eg papillary)
sorafenib or lenvatinib
Major prognostic factor in EBV associated nasopharyngeal
- postreatment EBV DNA levels
NO evidence of pretreatment EBV-DNA levels
What are reasons when larynx can’t be salvaged with CRT
- history of aspiration PNA
- nonvocal
- nasopharyngoscopic examination w/ diffuse hypomobility throughout his larynx, deep invasion of thyroid cartilage
*NOT cord immobility
First line for metastatic nasopharyngeal
Toripalimab + gemcitabine 1000 mg/m2/cisplatin
*Board answer is still probably cis/gem
What is considered locally advanced in nasopharyngeal?
N2- Bilateral cervical mets
T3 - Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses
*NOT extension to parapharyngeal space
what is mammary analogue secretory carcinoma?
Secretory salivary gland carcinoma
Tumor profiling of metastatic mammary analogue secretory carcinoma
NTRK
