Head and Neck (new threads)

Screening for 2nd primaries

Thu, 19 May 2011 06:45:27 +0000

Just a thought that's been bugging me lately—where does the idea of routine serial triple-scopy in follow-up of head and neck cancers stand? Would it help to diagnose 2nd primaries in a more effective way? What does the literature say?

Carcinoma LID

Sun, 15 May 2011 03:24:31 +0000

a patient with lid malignancy - squamous or sebaceous or adenoid cystic; which is locally advanced with involvement of orbit, regional lymphnodes - what would be options for such patients.
1) NACT followed by surgical salvage +/- RT
2) salvage surgery followed by radiotherapy
3) palliative radiotherapy.
if neoadjuvant chemotherapy is given; is there any difference in sensitivity of these histologies to chemo?
any direct literature evidence? or just derived discussion from general head and neck cancers?

Verrucous carcinoma of the buccal mucosa

Fri, 13 May 2011 14:18:03 +0000

This problem is being posted here for Dr Nilesh Mahale.

62/M
5*4 cm Rt BM lesion involving lower alveolar mucosa. No palpacble LN
Biopsy: Verrucous Ca
CT not done yet
Unfit for surgery due to cardiac morbidity.
What are the treament options?
Should we offer him radical RT as there is no other treatment option?

treatment of inoperable T4 buccal mucosa cancer

Tue, 10 May 2011 06:44:56 +0000

Hi,
i would like opinions regarding a case of buccal mucosa, T4N0 M0.
Middle aged patient presents with a buccal mucosa tumour, invading RMT and the mandible, inoperable even after 3 cycles of NACT.
What would now be the best course of action, considering a locally advanced tumour in a young patient with bone and skin involve ment.
Such cases are very comon in all cance OPDS.

High grade poorly differentiated minor salivary gland tumor

Sat, 30 Apr 2011 05:57:43 +0000

34 years old married lady ( Young, GC- very good)
Presented with swelling in left submandibular region and cheek x 1 yrs
was taking some non specific treatment outside
A biopsy from the lesion revealed High grade poorly differentiated minor salivary gland tumor.
CT scan shows: primary and Conglomerate nodal mass in left submandibular region, Tx involving RMT, L Buccal mucosa and reaching superiorly upto ITF.
Surgeon refused surgery i/v/o ITF involvement.
Now referred for Chemo-RT

What would be the optimal management
1. NACT —> Assess for surgery —> PORT
2. Radical Chemo Radiotherapy
If 2. then which chemo? schedule… ( presently planned for 3 weekly cisplat conc with RT)
RT.. Target, Dose, Is there in role of altered fractionation ( I am planning for IMRT to a dose of 66-70Gy)

We don't have neutrons… so what can b done within available resourses

Radiotherapy in pts with connective tissue disorders & vitiligo

Thu, 07 Apr 2011 08:14:25 +0000

In our practice we encounter patients with connective tissue disorders & vitiligo in whome radiation is indicated by virtue of malignancy stage.
We all have read in text books that they tolerate RT poorly
Given the oncological compulsions to irradiate them what are experiences of the member of this forum?

Childhood Naso-pharyngeal Carcinoma

Mon, 04 Apr 2011 18:09:07 +0000

What is the optimal radiation dose in Childhood Ca Nasopharynx and the role of neo adjuvant chemotherapy in this sub group.

Radiotherapy with a metallic plate.

Wed, 02 Feb 2011 17:57:50 +0000

55 yr old male, a case of post op Ca buccal mucosa. Just before starting RT pt had spontaneous # mandible while eating. The # was fixed with a metallic plate n pt is now due for RT with completely healed skin wound.
What would be important points to be considered before RT planning?

Whole neck IMRT Vs Low Ant Neck field with Split Beam Vs Gradient Matching

Mon, 24 Jan 2011 07:41:09 +0000

Excellent article discussing the pros & cons of 3 alternate head and neck IMRT techniques for supra-laryngeal primary tumors:

1.Whole neck IMRT
2.Upper head and neck IMRT with split beam matched low anterior neck fields
3.Upper head and neck IMRT with gradient matched low anterior neck fields

Link: http://download.journals.elsevierhealth.com/pdfs/journals/1879-8500/PIIS1879850010000056.pdf

Members' comments : would love to know which technique is preferred at different centers-i guess most centers have used all of the above and have decided to prefer one over the other - any particular reasons from your experience ?

I feel the final sentence sums up the practice @ Univ Florida : they use whole neck IMRT for patients with high risk of disease in the posterior portion of lower neck and matched ( split-beam or gradient matched ) low anterior neck fields with upper head and neck IMRT for patients with low risk of disease in the posterior portion of lower neck, since a standard prescription of 2Gy @ 3cm depth as they have followed would under-dose the posterior region of the lower neck.

H & N -- PET CT based target delineation

Fri, 14 Jan 2011 08:19:03 +0000

1)Can GTV delineation be on the basis of PET CT.
2) Any standard guidelines for Target volume delineation for PET CT based contouring?
3) In case of NPC if neo adjuvant chemotherapy is given - the volume delineation for 70Gy can be based on post chemotherapy PET or it has to be pre chemo PET volume only?
4) PET CT avid nodes to be as GTV nodal volume for 70 Gy and rest as high risk volume or the whole level needs to be included as 70 Gy volume?

Submandibular Salivary Gland Transfer

Thu, 06 Jan 2011 05:03:05 +0000

MRI in Head Neck Cancers.

Tue, 30 Nov 2010 02:57:28 +0000

Is there a role of MRI in Head Neck Cancers ? Which patients apart from Nasopharynx do you think MRI is helpful ?
Can pretreatment MR-spectroscopy and dynamic contrast enhanced MRI help in knowing Tumor Metabolism and Perfusion in Head and Neck Squamous Cell Carcinoma ?
Wanted to know how many of you actually think this will work and are looking at using these imaging tools.

Head Neck experts

Tue, 16 Nov 2010 01:39:15 +0000

Any comments about what molecular markers have made a difference in Head Neck cancers and how to use them in routine clinical practice?
Eg., p16 in Oropharyngeal Cancers ? p53 status or any other markers?

Is 95% to 95% the Benchmark ?

Fri, 15 Oct 2010 13:55:53 +0000

Dear friends,

I've always been perplexed when the physicist tells me that "its a nice plan as the 95% of PTV recieves 95% Dose" and he will have a beautiful DVH to support that. In the context of IMRT in head and neck cancer do you think this would hold good always. I have found references where IMRT plans are accepted with this criteria and a paper calls it "//The Minimum Benchmark for Plan acceptance". I would like to know the practice and may be discuss how much would we give and take in terms of coverage and hot spots.
Also if somebody could put some pieces of info on how we would apply the heterogeneity range set by ICRU in the context of a Head and neck SIB IMRT

Awaiting some enlightening pieces of information

Thanks

Dr Balukrishna S MD DNB DMRT
Assistant Professor
Radiation Oncology 1
CMC , Vellore

Hypoxic Cell Sensitizers and H&N Radiotherapy

Tue, 07 Sep 2010 12:33:17 +0000

For all the benefits of using hypoxic cell sensitizers, I do fail to understand why it is not being followed except in Denmark! Theoretically it is sound, technically feasible and we have a strong evidence in form a Phase III trial (DAHANCA 6& 7).

Seminars in Radiation Oncology has a lovely issue on Hypoxia (http://www.semradonc.com/issues/contents?issue_key=S1053-4296(00)X0016-1).

What is the opinion of the house- for or against?

Has anyone practised it? Where have you sourced Nimorazole (or any other drug) from?

Treatment Break

Wed, 18 Aug 2010 08:50:49 +0000

The options are:

leave the 2 week break to stand and suffer a 10-14% reduction in local control outcome (-0.6-1.0 Gy/[day of prolongation])
compensate for the break:
- accelerate after the break
  - 40Gy/20Fx @ 1/day = 4 weeks (conventional fractionation)
  - 10/7 break = 2 weeks
  - 30Gy/15Fx @ 2/day = 1 week + 2.5 day ('conventional' acceleration) with 6 hour delay. Maybe even weekend treatment?

Effect of 2-3 day prolongation will be small. His acute effects will be small as his mucosa will be undergoing ACCELERATED REPOPULATION.

H and N Ca

Mon, 09 Aug 2010 09:03:57 +0000

I am aware of risk of LN+ (from M.D. Anderson) data in Head and Neck Ca. That's according to each site.

Any data mentions the risk of LN involvement according to T stage in each site?

For example: What's the risk of LN+ in T1 Glottic Ca? We all know : Less than 2%

What about the other subsites?

Also According to nodal stage… Can we get the estimate of distant metastasis? I have it for NPC:

N0 : 0
N1: 2%
N2:5%
N3:14%

En total: 3%

Thanks

How important is RT QA

Thu, 01 Jul 2010 19:10:54 +0000

I will like to draw the attention to a recent review article by June Corry from Peter MacCallum highlighting some of the ways in which therapeutic ratio H&N cancer can be optimized further. One most intriguing hypothesis raised in the review based on the results of TROG 02.02 trial evaluating chemoradiation against chemoradiation + tirapazamine. There was almost a 20% improvement in Overall Survival with use of RT that adhered to the protocol. The author has raised an interesting point the Chemorad in some trials may be compensating for poor RT quality.
What are your thoughts on this issue? I for one know that poor RT results in a significantly poorer control having experienced it first hand as a part of my dissertation work.
A derivative issue is how is aggressive chemorad making these compliance issues worse?
I will like the opinion of the house in this regard and what are your views and methods to ensure good RT delivery to all / maximum patients that you follow (or will like to follow)?

Article Link http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W85-4YH9FHV-M&_user=1858992&_coverDate=03%2F31%2F2010&_fmt=full&_orig=search&_cdi=6645&view=c&_acct=C000052736&_version=1&_urlVersion=0&_userid=1858992&md5=5139b3999740e1872bba168c6f54383e&ref=full

Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Fri, 11 Jun 2010 11:27:47 +0000

42/F
Left Lateral Border tongue lesion
Biopsy: Squamus cell Ca
Dec 09 Lt Hemiglossectomy done
HPR: MDSCC pT not reported but depth 3 mm. All cut margins and base free
Neck observed as USG neck was normal
No adjuvant treatment
Lt nodal recurrence
Lt Modified neck dissection
HPR 2 LN at level III involved with Perinodal extension and 1 at level I involved
Patient also has polycystic kidney disease bilaterally with renal calculi ( s Creat Normal) hence concurrent cisplatin/ carboplatin deemed not suitable by med onco
Would like to discuss if there is any role for altered fractionation (On lines of OCAT trial at Tata Memorial )

Muco epidermoid Ca of minor salivary gland in BM

Tue, 08 Jun 2010 07:05:55 +0000

20/M
Lt BM ulcer
FNAC malignant cells ( mucoepidermoid ca/ adenoca/ adenoid cystic ca)
CT scan: lt BM mass. no significant LN enlargement
Lt BM w/e done
HPR: 2.2*1.7 muco epidermoid Ca of minor salivary gland, no LVI/PNI. C/M free
Post op 1 month developed Lt Ib LN
FNAC metastatic epidermoid ca
Lt MND HPR: 2/30 LN at 1b involved by metastatic muco epidermoid ca with minimal PNE

Should I offer concurrent chemo in addition to RT