MCQS
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 Jaiswal^3
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

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijc.IJC_571_19

1. 5
2. 10
3. 15
4. 20

1. 15.5% at 2 years
2. 21.5% at 5 years
3. 4.5% at 5 years
4. 9.5% at 5 years

1. Cisplatin 40 mg per sqm per wk
2. Wkly carboplatin AUC2
3. Cisplatin 100 mg per sqm q3wkly
4. 3 wkly carboplatin AUC 5–6

1. Age more than 75 years
2. Breaks during treatment
3. ECOG status
4. 3 weekly vs weekly cisplatin



1. All the above are true
2. 2 and 3 are true
3. 1, 2, and 3 are true
4. 1 and 2 are true

1. 8%
2. 18%
3. 28%
4. 38%

1. 32% at 3 months
2. 42% at 3 months
3. 12% at 3 months
4. 22% at 3 months

1. 98% and 61%
2. 50% and 88%
3. 88% and 50%
4. 61% and 98%

1. Neutropenia was more common with carboplatin
2. Thrombocytopenia was more common with cisplatin
3. Hyponatremia was more common with cisplatin
4. Hypercreatinemia was more common with carboplatin

1. Chemotherapy eliminates micrometastases
2. Chemotherapy causes tumor shrinkage
3. Chemotherapy causes DNA adduct formation
4. Chemotherapy reduces radiation toxicity

1. More comorbidities
2. Poor expected response
3. Poor hematopoietic reserve
4. Higher physiological age

» Answers and References

1. (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
2. (c) A meta-analysis by Pignon et al. showed an improvement in overall survival by 4.5% at 5 years
3. (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
4. (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
5. (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%
6. (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
7. (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
8. (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
9. (c) Chemotherapeutic agents act as radiosensitizers, causing potential damage by forming DNA adducts and cell cycle arrest in G2 phase
10. (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