Oropharyngeal Flashcards
RTOG 01-29
Remember as 29th Jan
Phase III randomized study
Stage II-IV SCCa of oropharynx, hypopharynx and larynx
accelerated CRT vs conventional CRT
regardless of HPV status
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Accelerated CRT
70Gy in 35 fx = 7 weeks
cisplatin 100mg/m2 x 3 cycles
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3 year OS: 70.3%
8 year OS: 48%
8 year PFS: 42%
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Conventional CRT
72Gy in 42 fx = 6 weeks
cisplatin 100mg/m2 x 2 cycles
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3 year OS: 64.3%
8 year OS: 48%
8 year PFS: 41%
Risk stratification as per RTOG 01-29
Remember as Jan 29th
- HPV Status
- Smoking
- T-Stage
- N-Stage
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Low Risk
HPV +ve, <10 PY smoking
HPV +ve, >10 PY smoking & N0-N2a
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Intermediate Risk
HPV +ve, >10 PY smoking, N2b-N3
HPV -ve, <10 pack year, T2-T3
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High Risk
HPV-ve, <10 PY smoking, T4
HPV -ve, >10 PY smoking
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flow chart that Dr. Malouff showed!
HPV Risk stratification
93 % vs 71% vs 46%
IMRT vs conventional for Xerostomia
38% IMRT
74% Conventional RT
Most common H&N Cancer
Oropharynx
Etiology
HPV +ve
HPV-ve (Tobacco, alcohol)
M>F
Anatomy of Oropharynx
Sup border: Soft palate
Inf border: Hyoid-linguial surface
Extends from BOT to PPW including the tonsils and soft palate
HPV +ve
Non-Keratinizing: Poorly differentiated
P16+ve = P53 (E6) and Rb (E7)
Younger pts
Mostly Tonsils and BOT
HPV -ve
Keratinizing
EGFR, P53
Smoking and Alcohol
Older pts
Poor Prognosis
P16 is a
surrogate marker for HPV
detected by IHC
Otalgia from CN IX
Jacobson nerve
unable to protrude tongue
Deep muscle invasion
Trimus
pterigoid muscle invasion
Labs/Imaging
CT with contrast
PET CT
MRI if thinking about PNI
Biopsy
FNA of LN if any
and biopsy of lesion via direct laryngoscope
Other consults
Speech
Nutrition
Dental
Hearing test
Smoking cessation
LN levels involved
II to IV
IB and V and RP less common <5%
Common distant mets
Lung and bone
HPV +ve staging
Nodal staging
HPV -ve staging
Clinical Nodal staging
RTOG 73-03
Remember as March 1973
Compared def RT vs surgery + RT for OPC
Similar OS for both arms
Chemotherapy
Concurrent Cisplatin for stage III and IV
Cisplatin dosage
100mg/m2 weeks 1,4,7 OR
40mg/m2 weekly
alternative chemo
Carboplatin + 5FU
Cetuximab: start 1 week prior to RT
RT doses
Definitive: 70Gy in 35 Fx, LN 56Gy in 35 Fx
RTOG 1016: high risk 66Gy low risk 50-52Gy
Re-irradiation
- Inclusion of recurrence, primary/nodal, area that has received previously 45Gy
- Improved DFS but not OS
Quad Shot
- Palliative regimen for H&N cancers
- 14.8Gy delivered BID for 2 days
- ## Can repeat Q4 weeks if good response
RTOG 00-22
Remeber as 1900 AD
Q: Hypofx IMRT for early stage oropharynx
Phase I/II trial
Chemo was not permitted
RT dose: 66Gy in 2.2Gy /fx to gross tumor
Low risk 54-60Gy in 1.8or2.0/fx
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2 year OS: 95.5%
2 year DFS: 82%
2 year LRF: 9%
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Good regimen to use with IMRT but toxicity was worse?
So long term side effects were crucial.
EORTC 22931 inclusion criteria
similar to USA RTOG 95-01
HPV +ve T staging
HPV-ve T staging
Overall TNM staging
Overall staging tips
HPV -ve
Pathological nodal staging
Lhermitte sign
Electric shock like sensation elicited by neck movement.
Observation is the treatment
Self limiting in 3-6 months
Happens when spinal cord received >40Gy
