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26 Cards in this Set
- Front
- Back
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H&N - Is T or N stage more important with regard to distant mets? |
N - 10% with N0-1, 30% N3 |
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H&N general T staging |
I- T1 II T2 III T3 or N1 IV - T4aN0/1 |
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H&N general N stagin |
N1 single ipsi 3m N2 single ipsi 3-6, or multiple, or bilat <6cm max N3 >6cm |
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H&N - when can you do selective neck dissection? |
cN0, selected N1 |
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H&N ENI vs elective neck dissection? Also, in ENI to whom must you radiate bilat? |
ENI = elective neck dissection Bilat - extensive tongue or soft palate, all T3-4 |
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H&N - when do you add RT after modified neck dissection? When do you add surgery after neck RT? |
RT after surgery - N2b, N3, ECE, multiple positive nodes Surgery after RT - residula >1.5cm, calcifications |
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H&N - after open biopsy of the neck - what's the initial treatment? |
RT! |
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H&N - recurrent or metastatic disease, whats' the benefit with combo chemo? |
only RR and QOL. maybe OS with TPF (still uncofirmed in the book)/ |
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H&N - EXTREME trial |
Cis/Carbo+5FU +/- cetuximab PFS 3.3-->5.6m, OS 7.5-->10m |
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H&N - indications for preop RT |
fixed nodes, postop RT will be delayed >8w, gastric pull-up, s/p open biopsy |
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H&N - indications for post-op RT |
Close or positive margins, ECE, multiple nodes, T4, LVI, PNI, >5mm subglottic invasion. Note 60-66Gy unless close or positive margins and then 70-74.4Gy |
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MACH-NC addition of chemo to RT adds what?> whats the sequence? In what instances can you use induction chemo? |
Only concomitant proven. 4% in 5y added OS Induction - for quick palliation to avoid PEG/tracheostomy, in organ-preservation when degree of response helps decide management, in patients with advanced neck disease at high risk for distant mets |
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MACH-NC data regarding combo chemo for definitive or adjuvant/neoadjuvant ChemoRT |
Combos do not impact survival. Most data for cisplatin, unclear if carbo equivalent |
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Results of Cetuximab as part of chemoRT |
RT vs concurrent cetuximab-RT - mOS 29-->49m for cetuximab, also improved PFS |
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H&N - Int0099 |
Advanced NPC (stage III/IV) to defnitive RT(70Gy) or conccurent CRT(cis) + 3 cycles maintenance cis-5fu. Improved local control, distant control, PFS, OS. Note only 50-60% completion in CRT arm. |
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H&N - Veterans organ preservation study |
CRT improved larynx preservation to 60%, better QOL. Note this study is induction chemo-->assessment-->responders go to definitive RT and non responders to salvage surgery |
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H&N - organ preservation RTOG91-11 |
larynx preservation study - RT alone, CRT induction(cis-5fU), CRT concomittant(cis) = better locoregional control and more larynx preservation with concomittant CRT. No OS difference. |
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H&N - Adjuvant RT vs CRT , and to whom? |
CRT better in terms of locoregional control, DFS, one study (EORTC) showed also improved OS. Final conclusion CRT for ECE or positive margins. RT is probably 60-66Gy with cis |
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H&N - follow up |
q1-3m y1, q2-4m y2, q4-6 y3-5, q6-12m thereafter |
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Larynx - treatment T1-2, T3-4 |
T1-2 - usually RT alone\ T3-4 - low volume disease (3.5cc) CRT, higher volume total laryngectomy with neck dissection and adjuvant CRT |
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H&N - RT dose to larynx(glottic) |
T1-2a 63Gy in 2.25Gy, T2b 65.25Gy T3-T4 74.4Gy (cone down after 45.6Gy) |
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H&N - treatment to supraglottic T1-T2, T3-4 |
T1-2 or low volume T3 <6cc - RT or partial laryngectomy. >6cm partial laryngectomy. stage III-III CRT. |
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NPC WHO types |
Type 1 SCC, type 2 nonkeratinzing, Type III - undifferentitated or lymphoepithelioma |
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NPC lympathic spread incidence |
80-90%, 50% bilat |
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NPC T stage, N stage |
T2 - parapharyngeal, T3 - bony structure, T4-intracranial N1-unilat <6cm, N2 bilat <6cm, N3 >6cm or supraclav |
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NPC treatment? |
RT/CR definitive, RT is to 74.4Gy at 1.2Gy bid |
