Anatomy
Clinical Presentation
Treatment Planning
Pathology
Management
100
The anatomical region where most nasopharynx cancers arise from.
What is the fossa of Rosenmueller?
100
5 risk factors for nasopharynx cancer.
What are EBV infection, smoking, ETOH, salted fish, rancid butter, wood dust, chemical exposure (formaldehyde), male gender, and positive family history.
100
8 acute side effects of RT.
•Fatigue
•Alopecia in field (base of skull)
•Radiation dermatitis
•Changes to hearing (non-inflammatory serous otitis)
•Mucositis
•Xerostomia
•Thickened oral secretions
•Pain requiring opioids
•Dysgeusia
•Odynophagia especially for solids
•Voice hoarseness
•Loss of appetite
•Weight loss
•10-20% need for a G-tube
•Aspiration
100
The non-keratinizing, differentiated type of NPC.
What is type II NPC.
100
Treatment recommendation for T2N1M0 disease.
What is concurrent chemoradiation.
200
The lateral anatomical border of the nasopharynx.
What is the parapharyngeal space?
200
8 presenting symptoms of NPC.
Epistaxis, nasal blockage, decreased hearing, tinnitus, otalgia, headaches, CN palsies, trismus, dysphagia, neck mass, vision loss, diploplia
200
Typical elective nodal regions to be covered.
Bilateral retropharyngeal, levels II-III-IVa-Va
200
These are 5 types of cancer that can be found in the nasopharynx.
Nasopharyngeal carcinoma, lymphoma, extramedullary plasmacytoma, sarcoma, salivary gland (e.g. adenoid cystic carcinoma), adenocarcinoma, mucosal melanoma, metastasis
200
Indications for induction chemotherapy.
What is T3N1+, T4Nany, TanyN2+
300
These are the 2 areas of weakness in the pharyngobasilar fascia.
1. Foramen lacerum
2. Sinus of Morgagni
300
T/F In nasopharynx cancer, there is no correlation between primary tumor size and presence of positive nodes.
What is true.
300
The anterior, posterior, and lateral borders of the elective 63Gy nasopharynx contouring volume.
Anterior: post 5mm nasal cavity OR 1/2-1/4 nasal cavity. Post 5mm maxillary sinus OR 1/4 maxillary sinus.
Posterior: 1/3 clivus if uninvolved, whole clivus if involved.
Lateral: 5mm margin on GTV of pterygoid muscle and parapharyngeal space OR lateral border of lateral pterygoid plate.
300
The name of the laboratory test that can be used to assess EBV status on a biopsy.
EBER-ISH.
300
Name one induction chemo regimen.
1. gem-cis
2. TPF
3. PF
400
Structure 5.
What is the abducens nerve (CN VI)?
400
The 4 most common sites of metastasis.
Bone, lung, liver, and distant nodes.
400
2 indications to cover level 1B in the elective nodal volume.
1. 1B involvement
2. IIA involvement >2cm or with cENE
3. Involving of oral cavity or anterior half of nasal cavity.
400
T/F: EBV LMP, p40, p63 are also positive stains often seen in NPC.
True
400
4 treatment options for locally recurrent NPC.
Endoscopic resection, maxillary swing surgery, repeat XRT+/-concurrent chemo, chemotherapy/immunotherapy, best supportive care.
500
The TNM stage if there is primary tumor invasion into the ethmoid sinus, multiple ipsilateral nodes with the largest measuring 6.5cm, no metastases.
cT3N3M0
500
5 year overall survival for stage III disease.
What is a 5 year OS of 80-90%
500
Desirable dose constraint for the optic chiasm. Also, max constraint.
Desirable: Dmax <54Gy
Max tolerable: Dmax <60Gy
500
Rare aggressive subtype of nasopharyngeal cancer starting with the letter "B", with poor long-term survival outcomes.
What is basaloid nasopharyngeal cancer.
500
4 planning/treatment strategies to reduce toxicity in re-irradiation cases.
1. Lower dose (e.g. 60-66Gy)
2. Give RT in 1.8Gy fractions
3. No elective nodal RT.
4. Use stereotactic shell to reduce PTV margins.
5. Add concurrent chemo.
6. Consider induction chemo to shrink volumes.
7. BID treatments (theoretical benefit)