Radiation Oncology Resident 4

The correct answer indicates that if a patient is positive for EBNA-1, the 3-year progression-free survival is 60% compared to 95% in someone without this antigen, and the overall survival is 65% compared to 97%. The incorrect answers provided do not accurately reflect the PFS and OS outcomes associated with being positive for EBNA-1.

Prognostic factors for NPX CA include high levels of viral capsid antigen IgG, decreased IgA, low EBV, and WHO II-III grade. The incorrect answers provided do not align with the established prognostic factors for this condition.

The correct answer is through the foramen lacerum and Rosenmullers fossa because these are the primary pathways for neoplasms originating in the nasopharynx to spread to the cavernous sinus and middle cranial fossa.

The cavernous sinus contains CN III (Oculomotor), IV (Trochlear), VI (Abducens), V1 (Ophthalmic) branches of the trigeminal nerve, and the internal carotid artery.

Invasion of the cavernous sinus typically presents with symptoms such as opthalmoplegia, orbital congestion, and proptosis. These symptoms are key indicators of involvement of the cavernous sinus.

Undifferentiated (WHO III) histologic type of NPX cancer has the highest rate of LN mets due to its aggressive nature and lack of differentiation.

The correct answer is based on the specific rates of lymph node metastasis for WHO grade I and grade II NPX cancer as provided in the question. It is essential to understand the accurate percentages for each grade to assess the metastatic potential accurately.

The correct 5-year overall survival rates for WHO grade 1, grade 2, and grade 3 NPX cancer are 35%, 55%, and 60% respectively. These rates reflect the varying prognoses associated with different grades of NPX cancer.

The correct answer describes the specific neurological symptoms associated with postsphenoidal syndrome of Jacod involving cranial nerves III-VI. The incorrect answers provide unrelated definitions to mislead test takers.

The correct order of loss of function of CN with cancer extending through foramen lacerum to cavernous sinus is VI then V1-2 then III then IV.

The correct answer includes the various cranial nerves involved in the syndrome along with specific symptoms like taste change, dysphagia, and pharynx numbness.

Trotter's Triad, also known as Vernet Syndrome, consists of decreased hearing, impaired soft palate movement, and mandibular neuralgia. The correct answer highlights the three specific components of this medical condition.

Jackson's syndrome refers to a rare neurological condition where there is a lesion (LN) at the base of the skull leading to the loss of function of cranial nerve XI (spinal accessory nerve) and cranial nerve XII (hypoglossal nerve). This results in specific symptoms related to the affected nerves.

The laryngeal click is produced by the larynx during swallowing. When the laryngeal click is lost, it indicates a dysfunction in the laryngeal area. Post-cricoid invasion via anterior displacement of the larynx can lead to the loss of laryngeal click.

When H&N oropharynx cancer invades into the parapharyngeal space, it can result in specific symptoms such as CN XII deficit, Syncope, Horner's syndrome, and Hoarse voice. Weight gain, joint pain, and fever are not typically associated with this specific scenario.

Trismus in head and neck tumors is commonly caused by the invading tumor affecting the pterygoid musculature or coronoid process of the mandible, leading to restricted mouth opening. The incorrect answers provided do not accurately address the specific mechanism for trismus in this context.

Supraglottic laryngeal cancer has been reported to have the highest risk for development of second cancer compared to other H&N cancer subtypes.

In head and neck cancer patients, the annual incidence rate of secondary tumors is approximately 3-4%, contributing to an overall incidence of 10-15%.

The correct answer is 24% vs 4%. This information highlights the significant difference in the rate of secondary cancer between patients treated with cis-retinoic acid and those who received a placebo at MD Anderson Cancer Center.

The correct answer is to start postop XRT for head and neck CA at 4-6 weeks, with an absolute deadline of 12 weeks postop to ensure optimal outcomes.

The correct answer describes the specific hyperfractionation regimens used by University of Florida and MD Anderson Cancer Center, highlighting the differences in dose and frequency between the two institutions.

In RTOG 9003, the local control (LC) and overall survival (OS) rates varied between the different treatment regimens, with the correct percentages provided in the answer section.

The correct answer specifies the patient group (T2-3 N0-1 OP tumors), the treatment arms (2/70Gy vs 1.15 BID to 80Gy), and the outcomes (improved LC and trend towards improved OS). The incorrect answers provide variations in patient characteristics, treatment arms, and tumor types to test understanding of the study details.

The correct answer refers to Waldeyer’s ring, which includes the nasopharynx (NPX), base of tongue (BOT), and tonsils. These sites are commonly associated with unknown head and neck primary cancer.

Squamous cell carcinoma (SCC) commonly arises from epithelial tissues, making head and neck, esophagus, lung, or GI the most likely primary sites when found in a low neck node. Breast, prostate, and ovary are less likely to be the primary sites for SCC in this scenario.

The correct answer describes the specific treatment arms and outcomes associated with the Calais French trial of H&N cancer, highlighting the improvements in OS, DFS, and LC for Stage III and IV oropharynx patients receiving 70Gy radiation with or without chemotherapy.

In postoperative cases of head and neck cancer with clinically negative neck or negative surgical margins without extracapsular extension, the typical radiation therapy dose administered is 54Gy.

The correct minimum postop XRT dose for H&N CA based on Per Peters MDACC H&N paper is 57.6Gy with a boost to 63Gy for increased risk areas like ECE. The incorrect answer options provide variations in dosage that are not in line with the findings of the paper.

The high risk factors for H&N cancer in the study include oral cavity primary, close or +margins, PNI, Stage IV, and ECE. The incorrect answers provided do not align with the findings of the study.

The correct XRT dose for head and neck cancer patients with positive margins after resection is typically 66-70 Gy to ensure adequate treatment.