Head & Neck Cancer: MCQ bank

Which is the commonest cancer among men in India (GLOBOCAN 2022)?

1. AStomach cancer
2. BLung cancer
3. CProstate cancer
4. DColorectal cancer
5. ELip and oral cavity cancer

Which habit is the main cause of buccal mucosa cancer in India?

1. AChewing tobacco and areca nut (gutka, khaini, pan)
2. BSpicy food
3. CMobile phone use
4. DDrinking hot tea
5. EUsing toothpowder

Which oral lesion carries the highest risk of malignant change?

1. AErythroplakia
2. BFordyce spots
3. CLinea alba
4. DHomogeneous leukoplakia
5. EGeographic tongue

Progressive trismus with blanched, stiff buccal mucosa in an areca nut chewer suggests:

1. AOral submucous fibrosis
2. BTemporomandibular joint dislocation
3. CCandidiasis
4. DTetanus
5. ELichen planus

A mouth ulcer persists 2 weeks after a sharp tooth was smoothed. What next?

1. AAntituberculous treatment
2. BReview in 6 months
3. CAnother course of antibiotics
4. DTopical steroid for a month
5. EBiopsy the ulcer

A 58-year-old gutka user has the tongue lesion shown (schematic). What is the most likely diagnosis of the right-sided lesion?

1. AAphthous ulcer
2. BSquamous cell carcinoma
3. CGeographic tongue
4. DTraumatic ulcer that needs no biopsy
5. EHerpetic ulcer

In the AJCC 8th edition, which feature was added to the oral cavity T category?

1. APerineural invasion
2. BGrade
3. CDepth of invasion
4. DTumour thickness
5. EHPV status

An oral tongue cancer measures 1.8 cm with DOI 7 mm. What is its T category?

1. AT3
2. BT4a
3. CT1
4. DT2
5. ETis

What is the preferred primary treatment for a resectable early oral cavity cancer?

1. AChemotherapy alone
2. BObservation
3. CImmunotherapy
4. DDefinitive radiotherapy
5. ESurgery

Which mandibular operation is needed when tumour invades the medullary bone?

1. ANo bone resection
2. BSegmental mandibulectomy
3. CAlveolectomy only
4. DCoronoidectomy
5. EMarginal mandibulectomy

Which free flap is the commonest choice to reconstruct a segmental mandible defect?

1. ALatissimus dorsi
2. BFibula
3. CRectus abdominis
4. DRadial forearm (soft tissue only)
5. ETemporalis

Which subsite is part of the oropharynx?

1. AAnterior two-thirds of tongue
2. BPyriform sinus
3. CHard palate
4. DBase of tongue
5. EVocal cord

Which virus causes most tonsil and base-of-tongue cancers in high-income countries?

1. AHPV type 16
2. BCMV
3. CEBV
4. DHSV-1
5. EHepatitis C

Which test is the standard surrogate for HPV in oropharyngeal cancer?

1. AEGFR IHC
2. BKi-67
3. Cp16 immunohistochemistry
4. DSerum SCC antigen
5. EPD-L1 TPS

The oropharyngeal tumour shows this staining pattern on p16 IHC (schematic). How is it interpreted?

1. ALymphoma
2. Bp16-positive: HPV-associated, staged with the HPV table
3. Cp16-negative
4. DNon-diagnostic
5. EMelanoma

A 44-year-old non-smoker has a painless cystic lump at level II (CT schematic). What is the most likely diagnosis?

1. ATuberculous lymphadenitis
2. BMetastatic HPV-associated oropharyngeal squamous carcinoma
3. CLipoma
4. DThyroglossal cyst
5. EBranchial cyst

Compared with HPV-negative disease, HPV-associated oropharyngeal cancer has:

1. AWorse survival
2. BMore bone invasion
3. CBetter survival
4. DIdentical survival
5. EMore second primaries

Which symptom typically brings glottic cancer to attention early?

1. AHaemoptysis
2. BStridor
3. COtalgia
4. DHoarseness
5. ENeck mass

Hoarseness for 4 weeks in a 60-year-old smoker. What should be done?

1. AAntibiotics and review in a month
2. BVoice rest only
3. CLaryngoscopy
4. DChest X-ray only
5. ESteroid inhaler

Why is elective neck treatment not needed for T1–T2 glottic cancer?

1. ARadiotherapy cannot treat the neck
2. BNeck dissection is dangerous
3. CThe neck is always involved
4. DThe true cords have sparse lymphatics, so nodal spread is rare
5. EIt is midline

Which site tends to present late with nodal disease and a poor prognosis?

1. ALip
2. BGlottis
3. CHypopharynx (pyriform sinus)
4. DLower gingiva
5. EHard palate

A laryngoscopy schematic is shown. What is the stage if the lesion is limited to one mobile cord and CT is normal?

1. AT1a N0 (stage I)
2. BT4a N0
3. CT1b N0
4. DT3 N0
5. ET2 N0

Which operation is used for a T4a larynx cancer with thyroid cartilage destruction?

1. ALaser cordectomy
2. BSupraglottic laryngectomy only
3. CTonsillectomy
4. DTracheostomy alone
5. ETotal laryngectomy with neck dissection

Which histology accounts for more than 90% of head and neck cancers?

1. ALymphoma
2. BMelanoma
3. CAdenocarcinoma
4. DSquamous cell carcinoma
5. ESarcoma

What is the first test for a hard neck node in an adult tobacco user?

1. AUltrasound only
2. BAntituberculous trial
3. CSerum ADA
4. DFine-needle aspiration cytology
5. EExcision biopsy of the node

When should PET-CT be done to assess response after chemoradiation?

1. AAbout 12 weeks after completion
2. B1 week after completion
3. CDuring week 4 of RT
4. DNever
5. E1 year after completion

Which drug is the standard radiosensitiser in head and neck chemoradiation?

1. ACisplatin
2. BMethotrexate
3. CCetuximab
4. DPaclitaxel
5. EGemcitabine

Within how many weeks of surgery should postoperative RT ideally start?

1. A3 months
2. B6 weeks
3. C12 weeks
4. DThere is no time limit
5. E6 months

How often should TSH be checked after radiotherapy to the neck?

1. AOnce at 5 years
2. BOnly if symptomatic
3. CEvery 6–12 months
4. DEvery 5 years
5. EWeekly

What is the main trigger for osteoradionecrosis of the mandible?

1. ADental extraction in irradiated bone
2. BFluoride use
3. CChewing gum
4. DBrushing teeth
5. EWearing a mouth guard

Which immune checkpoint inhibitor improved survival in platinum-refractory head and neck cancer in CheckMate 141?

1. AIpilimumab alone
2. BAvelumab
3. CDurvalumab
4. DAtezolizumab
5. ENivolumab

Which biomarker decides first-line pembrolizumab in recurrent/metastatic head and neck cancer?

1. AEGFR expression
2. BHER2
3. CPD-L1 combined positive score (CPS)
4. DTMB
5. Ep53

What proportion of recurrences of head and neck cancer appear within the first 2–3 years?

1. AAbout 50%
2. BAbout 10%
3. CAbout 80–90%
4. DAbout 30%
5. EAlmost none

Which screening is advised for a head and neck cancer survivor with a 30 pack-year history?

1. AMonthly chest X-ray
2. BYearly low-dose chest CT
3. CNo screening
4. DYearly PET-CT
5. ESerum SCC antigen

Which HPV protein targets p53 for degradation?

1. AE7
2. BE5
3. CE6
4. DL1
5. EE2

Why is p16 over-expressed in HPV-associated cancer?

1. AE7 inactivates Rb, removing feedback that normally limits p16
2. Bp16 is a viral protein
3. CE6 activates p16 directly
4. DCDKN2A is amplified
5. ETobacco induces p16

An adult has unilateral serous otitis media and a level V neck node. What must be examined?

1. AThe larynx only
2. BThe oral tongue only
3. CNothing; treat with antibiotics
4. DThe thyroid only
5. EThe nasopharynx, with a flexible nasoendoscope

Which virus is linked with most non-keratinising nasopharyngeal carcinomas?

1. AHTLV-1
2. BHIV
3. CHepatitis B
4. DHPV-16
5. EEpstein-Barr virus

Which imaging test best defines local extent of nasopharyngeal carcinoma?

1. ABarium swallow
2. BUltrasound of the neck
3. CPlain X-ray of the skull
4. DMRI of the nasopharynx, skull base and neck
5. EBone scan

A 46-year-old has a 1.8 cm lateral tongue SCC with DOI 4 mm and a clinically negative neck. Best management of the neck?

1. APET-CT and observe
2. BElective selective neck dissection (or SLNB in an expert centre)
3. CRadical neck dissection
4. DNeck RT alone
5. EObservation

In the Tata Memorial trial of elective vs therapeutic neck dissection, 3-year overall survival was:

1. A80% vs 67.5%
2. B67.5% vs 80%
3. C50% vs 50%
4. D95% vs 60%
5. E90% vs 89%

In Senti-MERORL, sentinel node biopsy compared with elective neck dissection gave:

1. AHigher neck recurrence
2. BWorse survival
3. CSimilar neck control and survival with less shoulder morbidity
4. DBetter survival
5. EMore complications

After partial glossectomy for T1 cancer the deep margin is 1.5 mm. Next step?

1. AImmunotherapy
2. BRe-excision of the margin
3. CNeck dissection only
4. DObservation
5. EChemoradiation

After resection of oral cancer, pathology shows clear margins, 2 positive nodes without ENE and perineural invasion. Adjuvant therapy?

1. AAdjuvant chemotherapy alone
2. BCetuximab with RT
3. CPostoperative chemoradiation
4. DPostoperative RT alone
5. EObservation

After resection, the neck node shows extranodal extension. Standard adjuvant therapy for a cisplatin-fit patient?

1. ART alone
2. BAdjuvant docetaxel alone
3. CCetuximab alone
4. DRT with concurrent cisplatin
5. EObservation

A 60-year-old edentulous man has a lower alveolar SCC with minimal cortical erosion on CT. Which bone operation is usually needed?

1. ASegmental mandibulectomy
2. BMarginal mandibulectomy
3. CNo bone resection
4. DCurettage
5. ECoronoidectomy

Why is a free flap recommended for most buccal mucosa resections?

1. ATo avoid neck dissection
2. BTo hide recurrence
3. CTo reline the cheek and prevent severe trismus
4. DBecause skin grafts are illegal
5. ETo shorten surgery

What does depth of invasion measure?

1. AFrom the tumour surface to its base
2. BThickness of the keratin layer
3. CFrom the basement membrane of adjacent normal mucosa to the deepest tumour
4. DDistance to the margin
5. EThe width of the ulcer

In the Kerala trial, three rounds of visual oral screening reduced oral cancer mortality among tobacco or alcohol users by about:

1. A2%
2. B29%
3. C50%
4. D0%
5. E75%

A cT4aN2b oral cancer is resectable and PD-L1 CPS is 15. Which strategy improved event-free survival in a randomised trial?

1. ANeoadjuvant RT alone
2. BPostoperative avelumab
3. CNeoadjuvant and adjuvant pembrolizumab with standard surgery and RT
4. DInduction cetuximab
5. EAdjuvant methotrexate

Why is HPV status not used to reduce treatment outside trials?

1. AHPV-positive cancers are more aggressive
2. BReplacing cisplatin with cetuximab in HPV-positive disease worsened survival
3. CThere are no trials
4. DHPV status is unreliable
5. ECisplatin does not work in HPV disease

An HPV-associated tonsil cancer is 1.5 cm with one ipsilateral 2.8 cm node. AJCC 8th stage?

1. AStage IVB
2. BStage III
3. CStage I
4. DStage II
5. EStage IVA

Same tumour, but the patient is p16-negative. Stage?

1. AStage III
2. BStage II
3. CStage IVB
4. DStage I
5. EStage IVA

A tumour is p16-positive but HPV DNA-negative. How does it behave?

1. ALike lymphoma
2. BBetter than double-positive
3. CClose to HPV-negative disease
4. DSame as double-positive
5. ELike nasopharyngeal cancer

What was the main finding of ORATOR (RT vs TORS + neck dissection for early oropharynx cancer)?

1. ATORS avoided all adjuvant therapy
2. BTORS improved survival
3. CNo patient needed a feeding tube
4. DRT caused more deaths
5. ESwallowing quality of life at 1 year was slightly better with RT, below the clinically meaningful threshold

A heavy smoker (40 pack-years) has p16-positive oropharyngeal cancer. What does smoking do to prognosis?

1. AIt only affects stage
2. BIt worsens it towards HPV-negative outcomes
3. CIt makes it nasopharyngeal
4. DIt improves it
5. ENo effect

Squamous cancer in a level II node with no primary on examination. Best order of investigation?

1. APanendoscopy, then PET-CT a week later
2. BPET-CT, then panendoscopy with bilateral tonsillectomy and directed biopsies
3. CChemotherapy and observe
4. DExcision biopsy of the node
5. ENeck dissection first

After chemoradiation for N2b disease, 12-week PET-CT shows complete metabolic response but a 1 cm residual node on CT. Management?

1. AImmediate neck dissection
2. BChemotherapy
3. COpen biopsy
4. DRe-irradiation
5. EObservation with surveillance

In RTOG 91-11, which arm had the best locoregional control?

1. ART alone
2. BInduction PF then RT
3. CTotal laryngectomy
4. DConcurrent cisplatin-RT
5. ECetuximab-RT

In the VA larynx trial, what proportion of patients kept their larynx after induction chemotherapy then RT?

1. ANone
2. BAll patients
3. CAbout 10%
4. DAbout 64%
5. EAbout 30%

A T1a glottic cancer in a 63-year-old. Which is an appropriate option?

1. ANeck dissection and observe the larynx
2. BChemoradiation with elective neck
3. CSmall-field RT or transoral laser cordectomy
4. DTotal laryngectomy
5. EPalliative care

Which supraglottic T2N0 plan is correct?

1. ATreat the primary with RT or transoral surgery plus bilateral elective neck (II–IV)
2. BChemotherapy alone
3. CTotal laryngectomy
4. DTreat the primary only
5. EIpsilateral neck only

After TPF induction for larynx preservation, why avoid bolus high-dose cisplatin with RT?

1. AIt is too cheap
2. BIt causes hypothyroidism
3. CSevere toxicity rises sharply after cisplatin-based induction
4. DIt reduces larynx preservation
5. EIt is ineffective

A man has had a total laryngectomy. Which option restores speech best for most patients?

1. ASign language only
2. BVocal cord injection
3. CTracheo-oesophageal puncture with voice prosthesis
4. DTracheostomy speaking valve
5. ECochlear implant

Why is radiotherapy alone usually chosen for a fit 76-year-old with stage III oropharyngeal cancer?

1. ACisplatin is banned in older adults
2. BRT alone is more effective
3. CChemotherapy added no survival benefit over age 70 in MACH-NC
4. DChemotherapy causes second cancers
5. EOlder patients do not tolerate IMRT

A patient with creatinine clearance 40 mL/min needs definitive RT for stage IVA cancer. Which sensitiser improved survival in an Indian randomised trial?

1. ACetuximab
2. BWeekly low-dose docetaxel
3. CMethotrexate
4. DBleomycin
5. ENimotuzumab alone

What is the absolute 5-year overall survival gain from concurrent chemoradiation in MACH-NC?

1. AAbout 1%
2. BAbout 15%
3. CAbout 25%
4. DAbout 6.5%
5. ENone

In the Indian ConCERT trial, weekly cisplatin with RT compared with 3-weekly cisplatin had:

1. ANon-inferior locoregional control and less severe toxicity
2. BMore vomiting
3. CWorse control
4. DMore kidney injury
5. ENo difference in toxicity

What did JCOG1008 show for postoperative chemoradiation?

1. A3-weekly was clearly superior
2. BWeekly cisplatin was non-inferior and less toxic than 3-weekly
3. CRT alone was best
4. DChemotherapy is unnecessary for ENE
5. ECetuximab was better

A patient progresses 3 months after cisplatin chemoradiation with lung metastases. Preferred next therapy (if available)?

1. AA PD-1 inhibitor (nivolumab or pembrolizumab)
2. BRepeat cisplatin
3. CCetuximab-RT
4. DObservation
5. ENeck dissection

For first-line recurrent/metastatic disease with CPS 30 and slow progression, which is reasonable?

1. AMethotrexate alone
2. BObservation
3. CPembrolizumab alone
4. DEXTREME only
5. ERe-irradiation alone

In KEYNOTE-048, pembrolizumab alone versus EXTREME had a LOWER response rate but longer survival. What explains this?

1. AResponse always equals survival
2. BDurable responses and long-term survivors in a minority on immunotherapy
3. CMeasurement error
4. DChemotherapy kills patients
5. ECrossover

A survivor 2 years after RT needs a molar extraction. Best approach?

1. ARoutine extraction at any clinic
2. BExtract and stop fluoride
3. CNever extract under any circumstances
4. DExtract and start bisphosphonate
5. ERefer to an oral surgeon experienced with irradiated patients; atraumatic extraction

Exposed mandibular bone at an extraction site 1 year after RT (OPG schematic). Diagnosis?

1. ADry socket only
2. BRecurrence certainly
3. COsteoporosis
4. DOsteoradionecrosis
5. ENormal healing

Which statement about surveillance imaging after head and neck cancer is correct?

1. ANo examination is needed if PET is negative
2. BCT every 3 months for life
3. CSerum markers replace imaging
4. DA post-treatment baseline is advised; routine serial scans thereafter are not proven
5. EPET-CT every month in year 1

What did adding cetuximab to cisplatin-RT achieve in RTOG 0522?

1. ANo improvement in outcomes, more toxicity
2. BBetter survival
3. CFewer distant metastases
4. DLess mucositis
5. EBetter larynx preservation

Which genomic pattern is typical of tobacco-driven (HPV-negative) head and neck cancer?

1. ABRAF V600E
2. BTP53 mutation and CDKN2A loss with chromosomal instability
3. CWild-type TP53 with TRAF3 loss
4. DNo copy-number changes
5. EE2F1 amplification with intact CDKN2A

What proportion of long-term partners of patients with HPV-associated oropharyngeal cancer had oncogenic oral HPV in a US study?

1. AAbout 90%
2. BNone could be tested
3. CAbout 50%
4. DAll partners
5. EAbout 4% overall, similar to the general population

p16 IHC on a fine-needle aspirate of a cystic neck node is equivocal. Best next step?

1. ARepeat p16 in 6 months
2. BAssume HPV-negative
3. CHPV DNA/RNA testing (PCR or ISH) on the cell block
4. DExcise the node
5. ETreat as lymphoma

After relapse, how did survival compare by HPV status in RTOG 0129/0522?

1. AHPV-positive tumours never relapse
2. BIdentical
3. COnly distant relapse differed
4. DWorse if p16-positive
5. EMedian 2.6 vs 0.8 years, better if p16-positive

A fit 42-year-old has stage IVA (T4N2) nasopharyngeal carcinoma. Standard treatment?

1. ART alone
2. BSurgery then adjuvant RT
3. CCetuximab with RT
4. DPalliative chemotherapy only
5. EInduction gemcitabine–cisplatin, then cisplatin-IMRT

After chemoradiation for N3 nasopharyngeal carcinoma, which adjuvant option improved failure-free survival?

1. AMetronomic capecitabine for 1 year
2. BObservation only is best
3. CWeekly docetaxel for 6 months
4. DTamoxifen
5. ECetuximab maintenance

Which statement about KEYNOTE-689 is correct?

1. ABenefit in event-free survival was confined to CPS ≥1, and overall survival was immature
2. BPathological complete response was about 50%
3. CIt was limited to HPV-positive disease
4. DIt replaced surgery
5. EIt improved overall survival in all patients

In NIVOPOSTOP, nivolumab added to postoperative cisplatin-RT:

1. AWas tested mainly in HPV-positive disease
2. BRequired CPS ≥20
3. CImproved distant control only
4. DReduced toxicity
5. EImproved 3-year DFS (63 vs 53%) mainly through locoregional control

Why did the Tata trial (Noronha 2018) favour 3-weekly cisplatin in the postoperative setting, unlike JCOG1008 and ConCERT?

1. AIt was a non-randomised study
2. BIt included only HPV-positive patients
3. CIt used a lower weekly dose, giving a lower cumulative dose
4. DWeekly cisplatin never works
5. EIt used cetuximab

A lateralised oral tongue cancer has DOI 0.8 mm. Recommended neck management?

1. ABilateral neck dissection
2. BNeck RT
3. CChemoradiation
4. DRadical neck dissection
5. EObservation

Borderline-resectable gingivobuccal cancer in a fit patient. Which approach may convert it to resectable?

1. ATPF induction chemotherapy, then reassessment for surgery
2. BObservation
3. CLow-dose methotrexate
4. DCetuximab alone
5. EBrachytherapy only

For which T1 oral site does guidance suggest observation of the neck?

1. AOral tongue with DOI 5 mm
2. BLower lip
3. CHard palate
4. DBuccal mucosa
5. ERetromolar trigone

In ARTSCAN III (mostly HPV-positive), cetuximab-RT compared with weekly cisplatin-RT had:

1. AMore locoregional failure (23 vs 9%)
2. BIdentical outcomes
3. CLess skin toxicity
4. DBetter survival
5. EFewer distant metastases

Which statement about de-escalation in HPV-associated oropharynx cancer is correct?

1. ART dose of 40 Gy is standard
2. BChemotherapy alone is enough
3. CIt is standard for all non-smokers
4. DIt remains investigational and should be done in trials
5. ECetuximab is the approved de-escalation drug

A p16-positive T2N1 (single 2.5 cm node, no ENE) tonsil cancer in a never-smoker. Which is a guideline-supported option?

1. ATrimodality therapy routinely
2. BChemoradiation with cetuximab
3. CDefinitive RT alone
4. DObservation
5. EInduction TPF then CRT

A p16-positive T3N2 oropharyngeal cancer. Preferred approach?

1. ACetuximab-RT
2. BInduction only
3. CTORS then chemoradiation
4. DRT alone
5. EDefinitive cisplatin chemoradiation rather than surgery followed by chemoradiation

Why is p16 not routinely tested in oral cavity cancer?

1. AIt changes the oral cavity T stage
2. Bp16 positivity there often does not reflect HPV-driven cancer and has unclear meaning
3. CIt is too expensive
4. DIt predicts cetuximab benefit
5. EIt is always negative

In RTOG 91-11 long-term follow-up, 10-year survival was:

1. A28% concurrent, 39% induction, 32% RT alone
2. BIdentical in all arms at 50%
3. C10% induction
4. D60% in all arms
5. E80% concurrent

Which patient is NOT a good candidate for larynx preservation?

1. AFit 55-year-old with T3 pyriform sinus cancer
2. BT3 glottic cancer with a fixed cord
3. CT2 supraglottic cancer
4. DN2b disease with a T2 primary
5. ET4a cancer with extensive thyroid cartilage destruction and a non-functioning larynx

In EORTC 24891 (pyriform sinus), induction PF then RT versus laryngectomy showed:

1. ABetter survival with induction
2. BNo difference in survival, with larynx preservation in many survivors
3. CNo patient kept the larynx
4. DMore distant metastases with surgery
5. EWorse survival with induction

Subglottic T2N0 cancer: which nodal levels need elective treatment?

1. ABilateral II–IV and level VI (paratracheal)
2. BLevel I only
3. CSupraclavicular only
4. DNone
5. EIpsilateral II only

Which patient is a candidate for curative re-irradiation?

1. AA patient with lung metastases
2. BPS 4
3. CAnyone with recurrence
4. DA fit patient with an unresectable in-field recurrence 3 years after RT, without distant spread, at an experienced centre
5. ERecurrence 2 months after RT with carotid blowout

After salvage resection of an in-field recurrence, pathology shows clear margins and no ENE. Postoperative re-irradiation?

1. AAlways
2. BOnly to the neck
3. COnly with SBRT
4. DNot routinely recommended
5. EOnly with cetuximab

In a Tata Memorial randomised trial, what did adding low-dose nivolumab to oral metronomic chemotherapy achieve?

1. AWorse survival
2. BOnly better response
3. COnly fewer side effects
4. DNo benefit
5. EImproved overall survival

Which first-line combination did NOT beat EXTREME in recurrent/metastatic disease?

1. APembrolizumab + platinum–5FU (KEYNOTE-048)
2. BPembrolizumab alone in CPS ≥20
3. CAll of the above beat EXTREME
4. DPembrolizumab alone in CPS ≥1
5. ENivolumab plus ipilimumab (CheckMate 651)

Which checkpoint-inhibitor strategy added to definitive chemoradiation improved outcomes?

1. ANone so far (JAVELIN H&N 100 and KEYNOTE-412 were negative)
2. BDurvalumab
3. CAvelumab
4. DPembrolizumab
5. ENivolumab–ipilimumab

Calculate: in KEYNOTE-048, 4-year OS was 19% with pembrolizumab–chemotherapy vs 5% with EXTREME. Roughly how many patients must be treated for one extra 4-year survivor?

1. AAbout 2
2. BAbout 50
3. CAbout 100
4. DAbout 20
5. EAbout 7

Calculate: the Tata docetaxel trial improved 2-year OS from 42% to 51%. Number needed to treat for one extra 2-year survivor?

1. AAbout 2
2. BAbout 100
3. CAbout 3
4. DAbout 11
5. EAbout 50

Erythropoiesis-stimulating agents given during head and neck RT (DAHANCA 10) resulted in:

1. ALess mucositis
2. BMore locoregional failure and worse survival
3. CNo effect at all
4. DFewer transfusions without harm
5. EBetter local control

Altered fractionation without chemotherapy (MARCH meta-analysis) improved survival most with:

1. AOnce-weekly RT
2. BSplit-course RT
3. CBrachytherapy alone
4. DHyperfractionation
5. EHypofractionation

Which is the most frequent site of a second primary cancer after head and neck SCC in smokers?

1. AProstate
2. BBrain
3. CBreast
4. DLung
5. EColon

A survivor has cough with meals and recurrent chest infections 4 years after chemoradiation. Most likely cause and test?

1. AAnxiety; reassurance
2. BGERD; endoscopy only
3. CLung metastases; PET-CT
4. DAsthma; spirometry
5. ELate radiation-associated dysphagia with aspiration; videofluoroscopy or FEES

For an isolated neck recurrence after prior neck dissection and RT, with multiple nodes and ENE on salvage surgery, what follows?

1. ALaryngectomy
2. BObservation only
3. CCetuximab alone
4. DPostoperative re-irradiation with chemotherapy in selected patients
5. ENothing can be done

In RTOG 0129, which group had 3-year survival of about 46%?

1. AHPV-positive women
2. BNever-smokers with HPV-positive T1
3. CHPV-positive with N0 disease
4. DHPV-positive with ≤10 pack-years
5. EHPV-negative with >10 pack-years (or T4)

In NRG-HN002, 60 Gy RT alone versus 60 Gy with weekly cisplatin in HPV-positive non-smokers showed:

1. AMore locoregional failure with RT alone (10 vs 3%); RT alone missed its PFS target
2. BNo locoregional failures in either arm
3. CRT alone became standard
4. DBetter PFS with RT alone
5. EWorse OS with chemotherapy

In ECOG 3311, what did 50 Gy versus 60 Gy adjuvant RT after transoral surgery achieve in intermediate-risk HPV-positive disease?

1. AMore toxicity with 50 Gy
2. BWorse survival with 50 Gy
3. CHigher distant metastasis with 50 Gy
4. DSimilar 3-year PFS (95 vs 94%) with less grade ≥3 toxicity (15 vs 25%)
5. ENo patient needed adjuvant RT

What is the current role of circulating tumour HPV DNA after treatment?

1. AUseful in HPV-negative cancer
2. BPromising for surveillance (high negative predictive value) but not yet standard
3. CReplaces PET-CT at 12 weeks
4. DScreening test for the general population
5. EUsed to choose cetuximab

First-line therapy for metastatic nasopharyngeal carcinoma with good performance status?

1. AMethotrexate
2. BPembrolizumab alone only if CPS ≥20
3. CObservation
4. DCisplatin–5FU–cetuximab (EXTREME)
5. EGemcitabine–cisplatin plus a PD-1 inhibitor

A resectable local recurrence of nasopharyngeal carcinoma 3 years after IMRT. Which approach gave longer survival in a randomised trial?

1. AObservation
2. BEndoscopic nasopharyngectomy rather than re-irradiation
3. CChemotherapy alone
4. DRe-irradiation once daily
5. EBrachytherapy alone

Which late effect is particularly important to monitor after nasopharyngeal radiotherapy?

1. APulmonary fibrosis
2. BHepatic fibrosis
3. CInfertility only
4. DHypopituitarism and temporal lobe necrosis
5. ECardiomyopathy