Jul 14, 2022
Question 1: Breast Cancer
- Hypofractionated whole breast irradiation with tamoxifen
- Conventional whole breast irradiation with tamoxifen
- Hypofractionated whole breast irradiation with aromatase inhibitor
- Conventional whole breast irradiation with aromatase inhibitor
Question 2: Head and Neck Cancers
Fourteen months ago, a 55-year-old man presented to an otolaryngologist with an enlarged left neck mass. Biopsy at the time showed squamous cell carcinoma. Direct laryngoscopy showed a remaining vocal cord tumor with no vocal cord fixation. The patient missed his follow-up appointment, and he continued to consume a twelve-pack of beer and a pack of cigarettes daily. He now presents with a much larger mass and hoarseness. Direct laryngoscopy shows a 2-cm left vocal cord mass limited to the larynx with vocal cord fixation. A swallowing study shows mild penetration of thin liquids, but overall his larynx is functional. A CT scan shows the above mass with bulky left-sided lymphadenopathy encasing the carotid artery. One node measures 6.5 cm. There is no thyroid cartilage invasion. A radiation oncologist determined it was not in the patient's best interest to pursue treatment at this time, owing to the bulk of the cervical lymphadenopathy.
- Refer for supportive care
- Refer for debulking surgery
- Cisplatin, followed by sequential radiation therapy
- Cisplatin, docetaxel, and fluorouracil (TPF), followed by concurrent chemoradiation
Question 1 Rationale and References
- Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145-52. DOI: https://doi.org/10.1016/j.prro.2018.01.012
- NCCN. National Comprehensive Cancer Network Guidelines in Oncology. Breast Cancer. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
Question 2 Rationale and References
- Lefebvre JL, Pointreau Y, Rolland F, et al. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II study [published correction appears in J Clin Oncol. 2013 May 1;31(13):1702]. J Clin Oncol. 2013;31(7):853-59. DOI: https://doi.org/10.1200/JCO.2012.42.3988
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Head and Neck Cancers. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf
- Blanchard P, Bourhis J, Lacas B, et al. Taxane-cisplatin-fluorouracil as induction chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013;31(23):2854-60. DOI: https://doi.org/10.1200/JCO.2012.47.7802