Chapter 111 : Radiation Therapy for Cancer of the Larynx and Hypopharynx

Question 1

Epiglottis is at what vertebral level

Answer 1

c3

Question 2

The distance of the anterior commissure to the skin may be within ____ cm

Answer 2

1 cm

Question 3

the lower border of the glottis extends ___ cm from the true vocal folds

Answer 3

0.5 cm or 5mm

Question 4

On a lateral plain film, all the subsites of the larynx can be delineated. What structure can be visualized as a figure-of-eight?

Answer 4

vocal folds

Question 5

Thyroid, cricoid and most of the arytenoid cartilages are what type of cartilage

Answer 5

hyaline cartilage

Question 6

The previously mentioned cartilages begin to ossify at what age?

Answer 6

20 years old

Question 7

The overexpression of this receptor was seen in head and neck SCCA and is associated with worse prognosis

Answer 7

EGFR

Question 8

What is the specific branch of CN nerve IX that causes the referred pain to the ear in patients with throat pain or odynophagia, in general

Answer 8

Arnold nerve

Question 9

This is the most important step or procedure in the diagnosis of laryngeal or hypopharyngeal cancer

Answer 9

Direct laryngoscopy and biopsy

Question 10

This is the standard radiation dose in patients with gross primary and gross lymphatic nodal disease

Answer 10

> 66 to 74 Gy

Question 11

What are the two major goals of treatment of laryngeal and hypopharyngeal cancers

Answer 11

1. cure of cancer and 2. preservation of organ function

Question 12

What are the superior and inferior boundaries of the hypopharynx?

Answer 12

Superiorly: SUPERIOR aspect of the hyoid bone (level of vallecula); inferiorly: INFERIOR border fo the cricoid cartilage

Question 13

What are the three subsites of the hypopharynx

Answer 13

1. paired piriform sinus, 2. postcricoid area, 3. posterior and lateral hypopharyngeal walls

Question 14

True or False: the aryepiglottic folds are part of the piriform sinus

Answer 14

FALSE. It is not part of the hypopharynx but the supraglottis

Question 15

True or False: HPV infection is associated with better prognosis in oropharyngeal ca

Answer 15

TRUE

Question 16

Cetuximab is a monoclonal antibody used to inhibit a receptor said to be associated with head and neck cancers. What is this receptor?

Answer 16

Epithelial growth factor receptor (EGFR)

Question 17

True or False: EGFR is associated with better prognosis in head and neck SCCA

Answer 17

FALSE

Question 18

A laryngeal cancer patient initially presents with hoarseness followed by dysphagia, which subsite of the larynx did the mass most likely started?

Answer 18

Glottis (Supraglottis usually starts with dysphagia and odynophagia, Subglottis are usually asymptomatic but dyspnea becomes the predominant symptoms)

Question 19

Referred pain of unilateral otalgia in layngeal cancer is cause by involvement of which branch of the Vagus Nerve?

Answer 19

auricular nerve of Arnold

Question 20

The main contraindication of definitive RT in early glottic cancers (TI or T2).

Answer 20

noncompliance with daily treatments for 6 to 7 weeks

Question 21

At which vertebral levels does each landmarks corresponds? 1. tip of epiglottis 2. vocal folds 3. cricoid cartilage

Answer 21

1. C3, 2. C4, 3. C6

Question 22

True or False: Extending defintive RT in early glottic cancers beyond 42 days results in superior outcomes

Answer 22

FALSE. There is a loss of approximately 1.4% (0.4% to 2.5%)
in local control for every day of a treatment break or
overall extension of treatment days which is secondary to accelerated repopulation by tumor cells.

Question 23

True or False: In advance hypopharyngeal cancers, it is preferred to have preoperative RT rather than postoperative RT.

Answer 23

FALSE. RTOG 7303 was a randomized trial that
compared preoperative (50 Gy) versus postoperative (60 Gy)
RT in advanced-stage, operable, supraglottic larynx and hypopharynx
cancers. The 10-year locoregional control was significantly improved in the postoperative versus the preoperative group (70% vs. 58%, respectively). Additionally, the rate of complications was much higher in the patients undergoing preoperative RT (9%) versus those in the postoperative group
(5%).

Question 24

What is the main disadvantage of a primary surgical approach in laryngeal cancer?

Answer 24

loss of organ function

Question 25

According to the Head and Neck Intergroup laryngeal Preservation trial, which of the following is a viable alternative to primary surgical approach for advance laryngeal carcinoma? A. RT alone, B. induction chemotherapy followed by RT, C. concurrent chemotherapy and RT, D. None proved to be of similar outcome compared to primary surgery followed by RT in advance laryngeal cancers.

Answer 25

C

Question 26

What is the first randomized study to evaluate a surgical versus a nonsurgical approach in laryngeal cancer?

Answer 26

Veterans Administration Laryngeal Preservation Trial

Question 27

What are the agents used in induction chemotherapy used by the Veterans Administration Laryngeal Preservation Trial for organ-preservation approaches in laryngeal cancers?

Answer 27

5-FU (fluorouracil) and cisplatin

Question 28

What radiation fractionation scheme for concurrent chemoRT aims to deliver the SAME TOTAL DOSE of radiation as standard fractionated RT in a SHORTER TIME INTERVAL to improve local control with theoretically the SAME LATE TOXICITY.

Answer 28

Accelerated fractionated RT

Question 29

What radiation fractionation scheme for concurrent chemoRT uses HIGHTER TOTAL DOSES of radiation in the SAME TIME INTERVAL as standard fractionated RT to potentially achieve at least the same local control but theoreticaaly with REDUCED LATE TOXICITY.

Answer 29

Hyperfractionated RT

Question 30

How often is a standard fractionated radiation given?

Answer 30

once a day

Question 31

Aside from conventional radiation therapy, new ways of radiation therapy includes IMRT and 3D-CRT. What does IMRT and 3D-CRT stands for?

Answer 31

Intensity-modulated radiation therapy, AND three-dimensional conformal radiation therapy

Question 32

Typically, locoregional tumor control rates are influenced by the ability to control both the primary tumor and nodal adenopathy. What then mostly influence the overall survival of patients with head and neck cancers?

Answer 32

Extent of nodal disease, which is a predictor of metastatic disease

Question 33

True or False: As with T1 glottic cancers, T1 supraglottic cancers need not require treatment of next-echelon, uninvolved lymphatic nodal regions.

Answer 33

FALSE. There is propensity for subclinical metastases in supraglottic cancers

Question 34

What site has the worst prognosis of any head and neck cancer?

Answer 34

hypopharyngeal carcinoma

Question 35

Supraglottic cancer may present has throat pain and odynophagia. Referred pain to the ear can also be experienced due to involvement of what SPECIFIC nerves? CN ____ and ______

Answer 35

CN