Skip to main content

Case Study 12

For each question, choose the answer you think is correct. See the end of this page for the answers.

Dual modality case study – patient H.N.

H.N. is a 47 year old male diagnosed with locally advanced squamous cell carcinoma of the oropharynx (related to HPV). He is scheduled to start a combination treatment with cisplatin and radiation therapy as per the HNLAPRT dual modality protocol.

Lab results taken 24 hours prior to starting treatment:

Lab valuePatient's labsNormal range
WBC5.14 – 10 x 109/L
ANC7.32 – 7.5 x 109/L
Hgb
152115 – 155 g/L
Plt244150 – 400 x 109/L
SCr14545 – 90 umol/L
Calculated CrCl74≥ 60 mL/min/1.73m2
Calcium 2.312.10 – 2.60 mmol/L
Magnesium 0.920.64 – 0.98 mmol/L
Sodium 140135 – 145 mmol/L
Potassium 4.83.5 – 5.0 mmol/L
Albumin4635 – 50 g/L
ALT61<50 U/L
Alk Phos8840 – 145 U/L
Total bilirubin3<17 umol/L
LDH206<225 U/L
Random blood glucose10.4
3.3 – 11 umol/L
Urea
5.5
2 – 9 mmol/L

Weight = 93.5 Kg, Height = 178.6 cm ECOG = 1

Choose ONE best answer:

1) Why is cisplatin used concurrently with radiation therapy?

  1. Cisplatin is a radiosensitizer
  2. Cisplatin is a chemosensitizer
  3. Cisplatin is effective only when used in combination with radiation therapy
  4. All of the above

2) What premedication regimen could be used for nausea treatment as per HNLAPRT protocol?

  1. Netupitant-palonosetron 300 mg-0.5 mg PO 30 to 60 minutes prior to cisplatin
  2. Ondansetron 8 mg 30 – 60 minutes prior to cisplatin and then 8 mg every 12 hours x 6 doses
  3. Dexamethasone 12 mg 30 – 60 minutes prior to cisplatin and then 4 mg every 12 hours x 6 doses
  4. Options 1 and 3 only
  5. All of the above

3) What additional supportive care measures may H.N. require during concurrent treatment?

  1. Placement of a feeding tube for nutritional needs
  2. Oral hygiene treatment with sodium bicarbonate mouth rinse or antifungals and antibiotics prn
  3. Pre and post hydration with D5W-1/2NS along with potassium chloride and magnesium sulfate
  4. Dry mouth treatment with pilocarpine tablets
  5. All of the above

4) What dose of cisplatin should H.N. receive during concurrent radiation therapy treatment?

  1. 215 mg once every 3 weeks for up to 3 cycles
  2. 215 mg once every week for up to 3 cycles
  3. 172 mg once every 3 weeks for up to 3 cycles
  4. 172 mg once every week for up to 3 cycles

5) What dose of RT would H.N. receive?

  1. 7000 centigrays in 35 weeks
  2. 7000 grays in 35 weeks
  3. 7000 centigrays in 35 doses
  4. 7000 grays in 35 doses

6) Labs prior to Cycle 2 of concurrent RT show that patient's ANC is 1.2 x 109/L and platelets are 110 x 109/L. How should the prescriber proceed?

  1. ANC and platelets are within normal range; continue 100% dose as prescribed
  2. ANC is low but platelets are within normal range; continue 100% dose as prescribed
  3. ANC is low, reduce cisplatin dose to 75%; proceed with RT as prescribed
  4. ANC is low, delay cisplatin and RT. Repeat weekly CBC

7) Labs prior to Cycle 3 of concurrent RT show serum creatinine of 200 µmol/L. What dose of cisplatin should this patient receive?

  1. 215 mg
  2. 172 mg
  3. 129 mg
  4. No dose change required

8) H.N. was weighed again prior to Cycle 3 of concurrent treatment. His current weight is 86 Kg. What dose of cisplatin should this patient receive?

  1. 207 mg
  2. 155 mg
  3. 124 mg
  4. No dose change required

9) What type of RT is used when given as a part of the HNLAPRT dual modality protocol?

  1. 3D Conformal Radiation Therapy (3DCRT)
  2. Intensity Modulated Radiation Therapy (IMRT)
  3. Volumetric Modulated Arc Therapy (VMAT)
  4. Stereotactic Radiation Therapy

10) Which of the following organs are considered organs-at-risk for the purposes of HNLAPRT dual modality protocol?

  1. Spinal cord, brainstem, optic nerves, optic chiasm
  2. Parotid glands, submandibular glands
  3. Auditory apparatus, brachial plexus
  4. All of the above
  5. None of the above

The correct answer is 1.


Rationale: Cisplatin is a radiosensitizer

The correct answer is 4.


Rationale: Either aprepitant and ondansetron OR netupitant-palonosetron (without ondansetron) along with dexamethasone are required premedications as per the HNLAPRT protocol. ‎

The correct answer is 5.


Rationale: As per the supportive care section of the HNLAPRT protocol, patients may require the placement of a feeding gastrostomy tube prior to treatment if there has been significant weight loss (ie. greater than 10% from baseline). They may also require use of standard oral hygiene during treatment (sodium bicarbonate mouth rinse, nystatin/fluconazole for fungal infections, antibiotics for documented infections). Pilocarpine (SALAGEN®) tablets may be used during radiation (usual dose 5 mg PO tid) to treat xerostomia.‎

The correct answer is 1.


Rationale: As per the BC Cancer protocol HNLAPRT treatment section, cisplatin 100 mg/m2 is given every 3 weeks for up to 3 cycles during concurrent RT. ‎

The correct answer is 3.


Rationale: As per the BC Cancer protocol HNLAPRT treatment section, 7000 cGy RT is given in 35 fractions (doses).‎

The correct answer is 3.


Rationale: As per the BC Cancer protocol HNLAPRT dose modification section, if patient's ANC is 1.0 to less than 1.5 x 109/L OR platelets are 75 to less than 100 x 109/L, cisplatin dose should be reduced to 75% (161 mg). RT continues as planned.

The correct answer is 3.


Rationale: Using the Cockcroft-Gault formula, his calculated creatinine clearance is 53 mL/min. As per the BC Cancer protocol HNLAPRT dose modification section, if patient's calculated creatinine clearance is 45 to less than 60 mL/min, cisplatin dose should be reduced to 80% of previous dose. Dose of cisplatin at Cycle 2 was 161 mg, so 80% of that dose would be 129 mg. RT continues as planned.

The correct answer is 4.


Rationale: As the weight loss is less than 10% from baseline and does not lead to a 5% variance from the prescribed dose, a dose reduction/change is not required.‎

The correct answer is 2.


Rationale: As per the radiation therapy treatment section of the HNLAPRT protocol, for locally advanced head and neck cancer, radiation is delivered using the IMRT technique.‎

The correct answer is 4.


Rationale: As per the radiation therapy treatment section of the HNLAPRT protocol, critical organs-at-risk include spinal cord, brainstem, optic nerves and optic chiasm, parotid glands, submandibular glands, auditory apparatus, and brachial plexus.‎



SOURCE: Case Study 12 ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © BC Cancer. All Rights Reserved.

    Copyright © 2022 Provincial Health Services Authority