Which of the following factors most adversely affects patients receiving radiation therapy for squamous cell carcinoma of the head and neck?

Related MCQs

• A 61-year-old man with a 120-pack-year smoking history is evaluated for a persistent and worsening cough and found to have a 3-cm mass in the right upper lobe on chest radiography. CT-directed needle biopsy is positive for squamous cell carcinoma. CT scans of the abdomen and pelvis, bone scan, and MRI of the head are negative for metastatic disease. Positron emission tomography scan shows uptake only in the right upper lobe mass, and pulmonary function tests indicate that the patient has adequate pulmonary reserve to undergo resection. The patient undergoes a right upper lobectomy. All margins are clear, and all peribronchial lymph nodes are negative for tumor within the resected specimen. What is the most reasonable adjuvant therapy for this patient?
• A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness. He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3, M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis revealed that EGFR and K-ras genes were both wild type. What is the most appropriate first-line therapy?
• A 63-year-old man is evaluated because of new-onset hemoptysis and a 100-pack-year smoking history. Chest radiograph shows a 4-cm right perihilar mass, and bronchoscopic biopsy and cytologic evaluation of sputum confirm squamous cell carcinoma. There are no significant findings on physical examination, and the patient reports no weight loss.Complete blood count is normal except for a serum alkaline phosphatase level at 110 U/L. CT scans of the chest and abdomen show no mediastinal adenopathy. Results of a positron emission tomography scan are negative, except for the right perihilar mass.In which of the following situations would surgical therapy be offered?
• Primary surgery is most appropriate for patients with which of the following types of squamous cell carcinoma?
• A 58-year-old woman with a 60-pack-year smoking history is evaluated because of hemoptysis and weight loss. Chest radiograph and CT scan show a right perihilar mass with mediastinal adenopathy. The results of CT scans of the abdomen, bone scan, and MRI of the head are otherwise negative. Examination of a specimen by bronchoscopic biopsy confirms small-cell lung cancer, and the findings suggest limited-stage disease. After the patient completes mediastinal radiation therapy and four cycles of cisplatin and etoposide, repeat CT scans indicate that her disease is in complete remission. What is the best recommendation concerning further therapy?
• Which of the following results is associated with concurrent chemoradiation therapy versus radiation therapy alone for patients with locally advanced laryngeal cancer, based on the RTOG 91-11 study?
• A 44-year-old woman presented with post-coital bleeding. Investigation revealed a 2-cm grade 1, stage IB1 squamous cell carcinoma of the cervix. There was no evidence of lymphovascular space invasion. She had completed her family.What is the most appropriate treatment?
• Which of the following factors is NOT typically associated with improved overall survival for patients who present with unknown primary tumors of the head and neck region?
• A 44-year-old woman has a lumpectomy and radiation therapy for stage II breast cancer. She receives 6 months of chemotherapy. Her periods cease while she is receiving chemotherapy, and she remains amenorrheic. Her tumor was found to be rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back and her energy is returning, but she is having severe hot flushes that keep her awake at night. She is so tired during the day that she is unable to perform her job in a satisfactory manner. She also relates that she and her husband have been unable to have satisfying sexual relations because intercourse is painful for her. What would be the most appropriate treatment for this patient?
• A 45-year-old woman has recently undergone lumpectomy and radiation therapy for a stage II breast cancer. She received chemotherapy for 6 months. Her periods ceased while she was receiving chemotherapy, and she remains amenorrheic. Her tumor was rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back, her energy is returning, and she has no specific complaints, but she is worried about recurrence. In addition to routine follow-up, what is the most appropriate management of this patient?