Malignant Nonodontogenic Tumors

Question 1

Bilateral <3cm nodes

Multi ipsilateral <3cm nodes

Ipsilateral 5cm node

Ipsilateral 6cm node

Ipsilateral 2cm node

Answer 1

N2c - Bilateral <3cm nodes

N2b - Multi ipsilateral <3cm nodes

N2a - Ipsilateral 5cm node

N3 - Ipsilateral 6cm node

N1 - Ipsilateral 2cm node

Question 2

• Primary tx for H&N SCCa with bulky adenopathy
• Involved cervical nodes
• Uninvolved cervical nodes
• Fractionated dose regimen
• Reason for fractionated doses

Answer 2

• >66Gy
• 63Gy
• 60Gy
• 5x weekly for 7 weeks (1.8-2Gy / day)
• Allow normal cells to recover and tumor cells to enter radiosensitive cell cycle

Question 3

Stage I/II

Stage III N1 without ECE

Stage IV

Answer 3

• 80% at 5 yrs
• 50% at 5 yrs
• 9%

Question 4

PET

PPV N0 neck

NPV N0 neck

PPV N+ neck

NPV N+ neck

Answer 4

PET

PPV N0 neck 68% (3/10 positive PETS actually have no neck mets)

NPV N0 neck 90% (1/10 negative PETS actually do have neck mets)

PPV N+ neck 88% (9/10 positive PETS have neck mets)

NPV N+ neck (inadequate data)

Question 6

(Montes, Carlson, H&N 2011) 146 patients (Max gingiva, alveolus, palate)

Answer 6

(Montes, Carlson, H&N 2011) 146 patients (Max gingiva, alveolus, palate)

Bottom Line: SND T2-T4 N0 Maxillary SCCa

• T1/T2 N0: Occult neck disease 6.8%
• T1 eventually 15% neck disease
• T2 28% eventually neck disease
• T3 55% eventually neck disease
• T4 52% eventually neck disease

Question 7

Borders of oncologic neck levels

Answer 7

Key landmarks:

Hyoid bone

Posterior border SCM

Sternohyoid/inferior border cricoid cartilage

Question 10

Adjuvant XRT

Adjuvant Chemo/XRT

Answer 10

• XRT = PNI, T3/T4, N2/N3
• Chemo/XRT = ECE, +margin

Question 11

Tumor size

Clinical Neck Exam

Distant Mets

Answer 11

T1 = <2cm

T2 = 2-4cm

T3 = >4cm

T4a = Bone erosion

T4b = Extension to dermis, muscles of mastication, etc