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24 Cards in this Set

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What is the incidence of second primary cancers for patients with a history of squamous cell cancer of the head and neck?
3-7% annually, particularly for other sites including lung, esophagus (and head/neck)
What is the difference between synchronous and metachronous head and neck cancers?
Synchronous occur within 6 months, metachronous more than 6 months apart.
What percentage of head and neck cancers are localized at the time of diagnosis?
90%
What are the four criteria for unresectability in head and neck cancer?
-base of skull involvement
-fixation to the prevertebral fascia
-carotid encasement
-pterygoid musculature
When is PET-CT indicated in the workup of head and neck cancer?
For patients with nasopharyngeal cancer with lymph node involvement, for whom the incidence of distant mets is 60%. Bone is the most common site.
PET can also be useful:
-when the primary is unknown
-to identify regional node involvement in the N0 neck
-in post treatment assessment
A 52 year old man with a long history of tobacco and alcohol abuse presents with hoarseness. Workup reveals a 1.5 cm primary squamous cell tumor of the larnyx, with one pathologic ipsilateral node 3 cm in diameter. How should he be managed?
Chance of cure is good with either radiation or surgery.
What are the treatment options for head and neck cancer patients with high-volume stage III or stage IV (no distant mets) disease?
If resectable, surgery and adjuvant radiation +/- chemo (based on risk factors). Concurrent chemoradiation can also be used for organ preservation. Surgery, in this case, can be used for salvage.
Which three structures are not spared in a radical neck dissection?
-internal jugular
-SCM muscle
-spinal accessory nerve
What is the timing of radiation therapy after surgery for head and neck cancer?
4-6 weeks.
What are the pros and cons of altered fractionation schedules for head and neck cancer?
Improves local control at the cost of increased acute toxicity.
What is the standard of car for head and neck cancer patients with positive resection margins or extracapsular extension?
Concurrent cisplatin and radiation.
A 48 year old woman has locally advanced but resectable cancer of the larynx, and she is interested in preservation of the larynx. How should she be counselled?
Her options include radiation only or concurrent chemoradiation; survival is the same but the chance of needing salvage surgery is twice as high if she gets radiation alone.
How are locally advanced (T3, T4 or N2, N3) cancers of the oropharynx treated?
With concurrent chemoradiation, to preserve speech and swallowing function.
How is management of locally advanced cancer of the hypopharynx different from management of locally advanced cancer of the larynx?
Induction chemoradiation is used for locally advanced hypopharyxnx cancers.
What is the standard of care for locally advanced unresectable head and neck cancer?
Radiation with concurrent high-dose cisplatin
What is the role for cetuximab (Erbitux) with radiotherapy in the treatment of head and neck cancer patients with advanced disease?
Indicated for use in patients in whom age, performance status and/or comorbid condition preclude the use of cisplatin or carboplatin.
What chemotherapy regimen is appropriate for patients with locally advanced cancers of the hypopharynx?
Induction chemotherapy with cisplatin + 5-FU or docetaxel, cisplatin and 5-FU
For nasopharyngeal cancer, how does WHO type affect response to chemotherapy and radiation?
WHO type I is squamous cell cancer.
WHO types II and III are more response to chemo and radiation.
What is the standard treatment for stage I or IIa nasopharyngeal cancer?
Radiotherapy alone.
What is the standard of care for stage IIb-IVb nasopharyngeal cancer?
concurrent cisplatin and radiotherapy followed by three cycles of adjuvant cisplatin + 5-FU
What therapy is used for metastatic or recurrent head and neck cancer?
If the patient can tolerate it and a significant amount of time has elapsed if they were previously treated, cisplatin and 5-FU with or without cetuximab is appropriate.
What is the historical gold standard single agent treatment for incurable recurrent or metastatic head and neck cancer?
Weekly methotrexate.
What is the indication for single-agent cetuximab in head and neck cancer?
Approved for use in platinum-refactory disease.
Which small molecule TKI inhibitor has activity in the setting of incurable recurrent/metastatic head and neck cancer?
erlotinib (Tarceva) has modest activity (~4% major response rate, ~50% disease stabilization). Avastin added to Tarceva bumped response rate to 17% and OS to 7.5 months in one study.