Head & Neck

Question 1

Poor prognostic factors in papillary thyroid cancer

Answer 1

1) Old (age over 55)
2) gross soft tissue invasion (extrathyroidal) of the tumor into the airway, nerves, or major vessels of the neck
3) extensive microscopic vascular invasion
4) inappropriately elevated serum thyroglobulin after initial therapy

Question 2

Histologic subtypes of papillary thyroid cancer with worse prognosis

Answer 2

tall cell, insular, and hobnail variants

Question 3

Biomarker for recurrence in papillary thyroid cancer

Answer 3

Serum thyroglobulin

Question 4

Biomarker for recurrence in papillary thyroid cancer

Answer 4

Serum thyroglobulin

Question 5

Genetic syndromes associated with increased risk for head and neck

Answer 5

• fanconi anemia
• dyskeratosis congenita

Question 6

oral cavity in head and neck anatomic compartment

Answer 6

• buccal mucosa, floor of mouth, anterior 2/3s of tongue, alveolar ridge, hard palate

Question 7

oropharyngeal in head and neck anatomic compartment

Answer 7

• tongue base
• tonsils
• inferior soft palate
• posterior phalanx

Question 8

Localized oral cavity management

Answer 8

Upfront surgery

Question 9

Adjuvant in head and neck generally speaking

Answer 9

Typically chemoradiation

Question 10

When surgery is preferred over CRT in laryngeal

Answer 10

1) Poor laryngeal function
2) At risk of chronic aspiration (ENT/rad onc will decide)
3) *T4

Question 11

Indications for adjuvant chemoradiation in head and neck

Answer 11

1) Positive margins
2) ECE

Question 12

Stage I nasopharyngeal management

Answer 12

• XRT alone

Question 13

Systemic therapy for induction chemotherapy in locally advanced nasopharyngeal

Answer 13

• cisplatin/gemcitabine
  *now phase III data for cisplatin/gemcitabine/sintilimab

Question 14

Systemic therapy for metastatic nasopharyngeal

Answer 14

Toripalimab + gemcitabine 1000 mg/m2/cisplatin 80 mg/m2

Question 15

1) First line systemic therapy for metastatic head and neck 2) based on PD-L1

Answer 15

Independent of PD-L1 (Dr. Walsh) AND liver mets OR substantial burden of disease, carbo (AUC5)/taxol (175)/pembro (PREFERRED over carbo/5-Fu, better tolerated and doesn’t involve continuous infusion. Robust Phase II data. KEYNOTE-B10 – ORR 48%, PFS 6 months but different dosing AUC 5 and taxol 175 (Gyn onc dosing) (can also do weekly carbo/taxol per Phase II)
IF CPS >20% AND no liver mets or rapidly progressive disease, pembrolizumab monotherapy (ORR ~20%, Hasn’t been compared to platinum/5-fu/pembro, only to extreme regimen in Keynote-048, most experts are starting with pembro and salvaging with chemo)
IF CPS < 1, carbo/taxol/pembro
IF immunotherapy ineligible, cetuximab + carbo/taxol
IF taxol contraindication or hypersensitivity, Carboplatin/5-Fu/pembrolizumab (BOARDS MAY SAY THIS IS SOC)

Question 16

RF for keratinizing vs. non-keratinizing nasopharyngeal

Answer 16

keratinizing = tobacco
non-keratinizing = EBV

Question 17

Management of locally advanced laryngeal with CR to induction chemotherapy

Answer 17

Definitive radiation

Question 18

Second line for metastatic head and neck after progression on extreme regimen

Answer 18

Pembro or Nivo

Question 19

When is p16 testing indicated

Answer 19

• oropharyngeal
  NOT oral cavity

Question 20

Adjuvant management of adenoid cystic carcinoma

Answer 20

• XRT (relatively high rate of local recurrence)

Question 21

first line for recurrent metastatic differentiated thyroid cancer (eg papillary)

Answer 21

sorafenib or lenvatinib

Question 22

Major prognostic factor in EBV associated nasopharyngeal

Answer 22

• postreatment EBV DNA levels
  NO evidence of pretreatment EBV-DNA levels

Question 23

What are reasons when larynx can’t be salvaged with CRT

Answer 23

• history of aspiration PNA
• nonvocal
• nasopharyngoscopic examination w/ diffuse hypomobility throughout his larynx, deep invasion of thyroid cartilage
  *NOT cord immobility

Question 24

First line for metastatic nasopharyngeal

Answer 24

Toripalimab + gemcitabine 1000 mg/m2/cisplatin
*Board answer is still probably cis/gem

Question 25

What is considered locally advanced in nasopharyngeal?

Answer 25

N2- Bilateral cervical mets T3 - Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses *NOT extension to parapharyngeal space

Question 26

what is mammary analogue secretory carcinoma?

Answer 26

Secretory salivary gland carcinoma

Question 27

Tumor profiling of metastatic mammary analogue secretory carcinoma

Answer 27

NTRK