Devita, Hellman, and Rosenberg's Cancer

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

202 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Cranial nerves II, III, IV, V, and VI can be affected by the tumor extend-

ing into the cavernous sinus. Lateral pharyngeal space extension of the

tumor affects cranial nerves IX through XII. Approximately 80% to 90%

of the patients have neck lymph node involvement at presentation with

half of the patients having bilateral neck disease. These tumors are almost

exclusively treated with radiation because it is very difficult to obtain a

complete resection. For more locally advanced tumors (node positive or

T3–4N0), chemoradiation with concurrent cisplatin followed by adjuvant

cisplatin–5FU is used.

Answer 17.14. The answer is D.

The treatment of choice for both benign and malignant tumors is primar-

ily surgical. Inoperable malignancies are treated by radiation therapy with

occasional success. Radiation therapy is given postoperatively for nearly

all high-grade lesions. Radiation therapy is advised for low-grade malig-

nant lesions that are recurrent and those with positive margins or narrow

margins on the facial nerve. Postoperative radiation therapy is advised

for selected benign mixed tumors when there is microscopic residual dis-

ease after operation and for nearly all patients after surgery for recurrent

disease.

Answer 17.15. The answer is B.

The treatment of head and neck cancer requires a multidisciplinary

approach. This is because the treatment will often require several differ-

ent modalities (e.g., surgery followed by chemoradiation) to support the

patient through treatment and recovery from the side effects. Radiation

to the head and neck has many short- and long-term toxicities. Short-

term side effects include severe mucositis with pain and inability to swal-

low and burns. The long-term effects include xerostomia, dental caries,

and fibrosis resulting in trismus and difficulty swallowing. The degree

of toxicity from radiation varies from patient to patient and depends on

the dose of radiation, the radiation port, the radiation technique, and

whether chemotherapy is used concurrently. IMRT is a radiation tech-

nique that allows varying doses of radiation to be given to different parts

of a radiation field. This allows a parotid gland to be spared resulting

in less long-term xerostomia. To decrease the risk of long-term swallow-

ing dysfunction, patients should be strongly encouraged to continue to

swallow to exercise the pharyngeal muscles even if they are receiving the

majority of nutrition via a G-tube.

Answer 17.16. The answer is C.

Prospective trials on secondary chemoprevention with isotretinoin and

-tocopherol have shown no significant benefit in preventing second pri-

mary cancers in patients with resected SCCHN. Tobacco smoking status

is an important risk factor for the development of second primaries and

never smokers have lower risk for second primaries compared to former

and current smokers.