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Head And Neck > Nasopharynx > Flashcards

Nasopharynx Flashcards

1
Q

Where is the most common site of NPC?

A

Fossa of rosenmuller

Bilateral projection of the nasopharyngeal just below the skull base (also lateral pharyngeal recess)

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2
Q

What are the first draining nodes of the nasopharynx?

A

Retropharyngeal (7a)

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3
Q

What virus is NPC associated with?

A

EBV

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4
Q

What are the 3 histological types of NPC?

A

Type 1: keratinising SCC - common in the west/Caucasians, difficult local control

Type 2: non-keratinising, (30%), EBV, CRT responsive, higher predilection for distant mets

Type 3: undifferentiated (50%), EBV, oriental

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5
Q

What investigations should be performed?

A 
EUA & biopsy
CT & MR neck
CT chest
PET if T3/N3
EBV titres
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6
Q

Describe T1

A

Confined to NP/OP/nasal cavity

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7
Q

Describe T2

A

Parapharyngeal extension

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8
Q

Describe T3

A

Bony involvement (skull base or paranasal sinuses, cervical vertebrae or pterygoid structures)

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9
Q

Describe T4

A

Intracranial extension, orbit, cranial nerves

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10
Q

Describe N1

A

Unilateral <=6cm or bilateral RP <=6cm ABOVE caudal cricoid

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11
Q

Describe N2

A

Bilateral cervical LN <=6cm ABOVE caudal cricoid

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12
Q

Describe N3

A

> 6cm or below cricoid

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13
Q

What is the main treatment option for all stages?

A

RT

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14
Q

When would you consider induction chemotherapy?

A

Stage 3 onwards (ie T3/4 or N2)

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15
Q

What induction chemotherapy is given?

A

TPF
Docetaxel 75mg/m2 D1, cisplatin 75mg/m2 D1, 5FU 750mg/m2 D1-5. q21d for 2-3cycles. Scan after 3 cycles

Dec 8mg BD day before/of/after and 5/7 GCSF from D7

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16
Q

When do you use chemoradiotherapy in NPC?

A

From stage II (ie anything over T1N0)

17
Q

Describe the CTVs and dose

A

CTV1 - 70Gy/33# - pre chemo GTVp +5mm

CTV1n - GTVn + 5mm, if ICT - residual GTVn +1cm

CTV2 - 63Gy - GTV +1cm and post 1/3 nasal cavity/maxillary sinus/ant 2/3 clivus. Start halfway through sphenoid and down to caudal C1

CTV3 - 56Gy - elective nodes - BL 2-5 &7a

PTV = CTV +4mm

18
Q

What chemotherapy regimen is used in metastatic disease?

A

Cisplatin 80mg/m2, gemcitabine 1g/m2 D1&8

PFS 7m, OS 29m

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