Devita, Hellman, and Rosenberg's Cancer

LWBK1006-17 LWW-Govindan-Review December 7, 2011 21:14

Chapter 17•Cancer of the Head and Neck 201

primary tumors that are T3 or T4, N2, or N3 disease, perineural invasion,

and vascular embolism. If the patient has any major risk factor or two

or more minor risk factors, adjuvant chemoradiation is recommended. If

the patient has a minor risk factor, adjuvant radiation is recommended.

If the patient has no adverse risk factors, observation is recommended.

Answer 17.10. The answer is B.

Cetuximab is an EGFR antibody that has been used to treat SCCHN.

It has been used alone or combined with chemotherapy for treatment

of metastatic disease, as well as with radiation, to treat locally advanced

SCCHN. In a multicenter, randomized phase III trial comparing chemora-

diation with cetuximab with radiation alone for SCCHN of the orophar-

ynx, larynx, and hypopharynx, cetuximab improved both local control

and overall survival. In patients receiving cetuximab with radiation, there

was increased incidence of acne and infusion reactions but no difference

in the incidence of mucositis. However, concurrent cetuximab with radi-

ation has not been compared with cisplatin and radiation.

Answer 17.11. The answer is D.

The treatment of larynx cancers has changed significantly over the last

20 years. The traditional approach to locally advanced tumors of the lar-

ynx was a total laryngectomy often followed by adjuvant radiation. With

improvements in surgical techniques and chemoradiation, it is often pos-

sible to preserve the larynx. For low-volume disease, a hemilaryngectomy

can be performed saving the voice. Nonsurgical treatments can also be

good options. Both radiation alone and concurrent chemoradiation for

locally advanced tumors of the larynx have equal chance of cure. Concur-

rent chemoradiation, however, gives the best local control; therefore, it

is the standard of care. Unfortunately, large-volume tumors of the larynx

may not be curable by chemoradiation or larynx-preserving surgery and

should be treated with a total laryngectomy.

Answer 17.12. The answer is B.

Adjuvant chemotherapy has been tested in several trials to improve the

survival of patients with SCCHN. Unfortunately, it has not been shown

to improve survival. Currently, adjuvant chemotherapy is only used in the

treatment of locally advanced nasopharyngeal cancer. Even its benefit is

unclear.

Answer 17.13. The answer is B.

Nasopharyngeal carcinomas are unusual in the United States but are much

more common in China and Southeast Asia. On the basis of pathol-

ogy, there are three subtypes of nasopharyngeal carcinoma: WHO type I,

squamous cell carcinoma; WHO type II, nonkeratinizing carcinoma; and

WHO type III, undifferentiated carcinoma or lymphoepithelioma. The

WHO type III is associated with EBV. These tumors typically present with

a painless upper neck mass, nasal stuffiness, facial pain, and headache.

Cranial nerve involvement occurs in approximately 25% of the patients.