Oropharyngeal

Question 1

RTOG 01-29

Answer 1

Phase III randomized study
Stage II-IV SCCa of oropharynx, hypopharynx and larynx
accelerated CRT vs conventional CRT
.
.

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%
.
.
Conventional CRT
72Gy in 42 fx = 6 weeks
cisplatin 100mg/m2 x 2 cycles
.
.
3 year OS: 64.3%
8 year OS: 48%
8 year PFS: 41%

Question 2

Risk stratification as per RTOG 01-29

Answer 2

HPV Status
Smoking
T-Stage
N-Stage
.
.
Low Risk
HPV +ve, <10 PY smoking
HPV +ve, >10 PY smoking & N0-N2a
.
.
Intermediate Risk
HPV +ve, >10 PY smoking, N2b-N3
HPV -ve, <10 pack year, T2-T3
.
.
High Risk
HPV-ve, <10 PY smoking, T4
HPV -ve, >10 PY smoking
.
.
flow chart that Dr. Malouff showed!

Question 3

HPV Risk stratification

Answer 3

93 % vs 71% vs 46%

Question 4

IMRT vs conventional for Xerostomia

Answer 4

38% IMRT
74% Conventional RT

Question 5

Most common H&N Cancer

Answer 5

Oropharynx

Question 6

Etiology

Answer 6

HPV +ve
HPV-ve (Tobacco, alcohol)
M>F

Question 7

Anatomy of Oropharynx

Answer 7

Sup border: Soft palate
Inf border: Hyoid-linguial surface
Extends from BOT to PPW including the tonsils and soft palate

Question 8

HPV +ve

Answer 8

Non-Keratinizing: Poorly differentiated
P16+ve = P53 (E6) and Rb (E7)
Younger pts
Mostly Tonsils and BOT

Question 9

HPV -ve

Answer 9

Keratinizing
EGFR, P53
Smoking and Alcohol
Older pts
Poor Prognosis

Question 10

P16 is a

Answer 10

surrogate marker for HPV
detected by IHC

Question 11

Otalgia from CN IX

Answer 11

Jacobson nerve

Question 12

unable to protrude tongue

Answer 12

Deep muscle invasion

Question 13

Trimus

Answer 13

pterigoid muscle invasion

Question 14

Labs/Imaging

Answer 14

CT with contrast
PET CT
MRI if thinking about PNI

Question 15

Biopsy

Answer 15

FNA of LN if any
and biopsy of lesion via direct laryngoscope

Question 16

Other consults

Answer 16

Speech
Nutrition
Dental
Hearing test
Smoking cessation

Question 17

LN levels involved

Answer 17

II to IV
IB and V and RP less common <5%

Question 18

Common distant mets

Answer 18

Lung and bone

Question 19

HPV +ve staging

Question 20

HPV -ve staging

Question 21

RTOG 73-03

Answer 21

Compared def RT with surgery + RT for OPC
Similar OS for both arms

Question 22

Chemotherapy

Answer 22

Concurrent Cisplatin for stage III and IV

Question 23

Cisplatin dosage

Answer 23

100mg/m2 weeks 1,4,7 OR
40mg/m2 weekly

Question 24

alternative chemo

Answer 24

Carboplatin + 5FU
Cetuximab: start 1 week prior to RT

Question 25

RT doses

Answer 25

Definitive: 70Gy in 35 Fx, LN 56Gy in 35 Fx
RTOG 1016: high risk 66Gy low risk 50-52Gy