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Year : 2019  |  Volume : 56  |  Issue : 3  |  Page : 267--268

MCQs for “Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants”

HS Darling1, S Jayalakshmi2, Pradeep Jaiswal3,  
1 Department of Medical Oncology and Hemato-oncology, Narayana Superspeciality Hospital, Gurugram, Haryana, India
2 Department of Radiation Oncology, Artemis Hospital, Gurugram, Haryana, India
3 Department of Surgical Oncology, Command Hospital, Bangalore, Karnataka, India

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-oncology, Narayana Superspeciality Hospital, Gurugram, Haryana
India




How to cite this article:
Darling H S, Jayalakshmi S, Jaiswal P. MCQs for “Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants”.Indian J Cancer 2019;56:267-268


How to cite this URL:
Darling H S, Jayalakshmi S, Jaiswal P. MCQs for “Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants”. Indian J Cancer [serial online] 2019 [cited 2020 Feb 25 ];56:267-268
Available from: http://www.indianjcancer.com/text.asp?2019/56/3/267/263040


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Select single best/correct answer:

Q1. Patients age over 70 years form ____% of the head and neck cancer burden in India

5101520

Q2. Concurrent chemoradiotherapy (CCRT) showed an improvement of ____% in overall survival compared with radiation alone in patients below 70 years of age

15.5% at 2 years21.5% at 5 years4.5% at 5 years9.5% at 5 years

Q3. Which of the following chemotherapy drugs/regimens is not used for CCRT

Cisplatin 40 mg per sqm per wkWkly carboplatin AUC2Cisplatin 100 mg per sqm q3wkly3 wkly carboplatin AUC 5–6

Q4. Which of the following factors predict statistically significant difference in disease-free survival in elderly patients undergoing CCRT

Age more than 75 yearsBreaks during treatmentECOG status3 weekly vs weekly cisplatin

All the above are true2 and 3 are true1, 2, and 3 are true1 and 2 are true

Q5. Mucositis is a toxicity which occurs during radiotherapy and chemotherapy. The combination of both results in an additive effect. The rate of severe mucositis in patients who received CCRT in this study was

8%18%28%38%

Q6. Feeding tube dependence was associated with a significantly higher risk of mortality. The rate of feeding tube dependence in patients of larynx/hypopharynx cancer in this study was

32% at 3 months42% at 3 months12% at 3 months22% at 3 months

Q7. In this study, the number of patients completing chemotherapy and radiotherapy, respectively, was

98% and 61%50% and 88%88% and 50%61% and 98%

Q8. False about the adverse effects is

Neutropenia was more common with carboplatinThrombocytopenia was more common with cisplatinHyponatremia was more common with cisplatinHypercreatinemia was more common with carboplatin

Q9. True about the role of chemotherapy in CCRT is

Chemotherapy eliminates micrometastasesChemotherapy causes tumor shrinkageChemotherapy causes DNA adduct formationChemotherapy reduces radiation toxicity

Q10. Potential issues in elderly patients in delivering CCRT are all except

More comorbiditiesPoor expected responsePoor hematopoietic reserveHigher physiological age

 Answers and References



(b) Head and neck cancers account for a major percentage of the cancer burden in India, and it has been estimated that around 10% of these patients are over 70 years of age(c) A meta-analysis by Pignon et al. showed an improvement in overall survival by 4.5% at 5 years(d) Cisplatin was administered weekly at 40 mg/m 2 or at 100 mg/m 2 if used three weekly (n = 14). Carboplatin was administered (n = 22) after calculating the creatinine clearance, with an area under curve (AUC) of 2(b) Factors predicting good disease-free survival (DFS) were ECOG status (1 vs 2) (P = 0.031) and completion of treatment without any breaks while on CCRT (P = 0.04). Patients older than 75 years had a negative trend in DFS compared with their younger counterparts (P = 0.08). There was no difference in DFS or OS between the weekly or three-weekly administered cisplatin groups(c) The rate of severe mucositis in patients who received CCRT in our study was 28%, which was lower than other studies that were in the range of 43%–45%(a) Feeding tube dependence was noted in 32%, tracheostomy dependence was noted in 10%, and both feeding and tracheostomy tube dependence were noted in 10% of patients with larynx/hypopharynx cancer at 3 months following completion of treatment(d) Only 61% of patients completed chemotherapy (defined as cumulative dose of 200 mg/m 2 of cisplatin and five weekly dose of carboplatin at AUC 2. All but one patient (98%) completed radiation, with no treatment-related death(a) The most common hematological toxicities with cisplatin were neutropenia (grade III in 26% and grade IV in 7%) and thrombocytopenia (grade III in 11% and grade IV in 2%). Carboplatin was associated with higher grades of hypercreatinemia (grade III in 9% and grade IV in 2%). Interestingly, all the patients who developed hyponatremia were on cisplatin chemotherapy(c) Chemotherapeutic agents act as radiosensitizers, causing potential damage by forming DNA adducts and cell cycle arrest in G2 phase(b) Another consideration in administering chemotherapy to the elderly is a reduced hematopoietic reserve, predisposing them to chemotherapy-induced myelotoxicity. Clinically, however, it is important to distinguish chronological age from physiological age, where depending on the performance status and presence of comorbid illness, the toxicity profile of patients may resemble either patients of an older or younger age group

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Conflicts of interest

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