Oropharyngeal

Question 1

RTOG 01-29

Remember as 29th Jan

Answer 1

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

Accelerated CRT
70Gy in 35 fx = 7 weeks
cisplatin 100mg/m2 x 3 cycles
.
.
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

Remember as Jan 29th

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

Answer 19

Nodal staging

Question 20

HPV -ve staging

Answer 20

Clinical Nodal staging

Question 21

RTOG 73-03

Remember as March 1973

Answer 21

Compared def RT vs 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

Question 26

Re-irradiation

Answer 26

- Inclusion of recurrence, primary/nodal, area that has received previously 45Gy - Improved DFS but not OS

Question 27

Quad Shot

Answer 27

- Palliative regimen for H&N cancers - 14.8Gy delivered BID for 2 days - Can repeat Q4 weeks if good response -

Question 28

RTOG 00-22 | Remeber as 1900 AD

Answer 28

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 . . . 2 year OS: 95.5% 2 year DFS: 82% 2 year LRF: 9% . . Good regimen to use with IMRT but toxicity was worse? So long term side effects were crucial.

Question 29

EORTC 22931 inclusion criteria similar to USA RTOG 95-01

Answer 29

Question 30

HPV +ve T staging

Answer 30

Question 31

HPV-ve T staging

Answer 31

Question 32

Overall TNM staging

Answer 32

Question 33

Overall staging tips

Answer 33

Question 34

HPV -ve

Answer 34

Pathological nodal staging

Question 35

Lhermitte sign

Answer 35

Electric shock like sensation elicited by neck movement. Observation is the treatment Self limiting in 3-6 months Happens when spinal cord received >40Gy