Head and neck tumours: larynx preservation by induction chemotherapy: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Head and neck tumours: larynx preservation by induction chemotherapy

Sample item

A 58-year-old man with a T3 glottic carcinoma wants to keep his larynx. After induction chemotherapy with cisplatin and fluorouracil, the primary shows a good response. What is the next step in this protocol?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Definitive radiotherapy, with salvage laryngectomy for non-responders

The Veterans Affairs larynx trial showed that induction chemotherapy followed by radiotherapy in responders preserves the larynx in about two thirds of patients without compromising survival. Poor responders undergo laryngectomy. Concurrent chemoradiotherapy is now the usual alternative.

Option by option

  • A. Definitive radiotherapy, with salvage laryngectomy for non-responders (correct)

    Correct. Responders receive radiotherapy and non-responders surgery.

  • B. Observation only

    Observation leaves the tumour untreated.

  • C. Immediate total laryngectomy

    Immediate laryngectomy defeats the purpose of preservation.

  • D. Repeat chemotherapy for 1 year

    Prolonged chemotherapy alone is not curative.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Definitive radiotherapy, with salvage laryngectomy for non-responders. The Veterans Affairs larynx trial showed that induction chemotherapy followed by radiotherapy in responders preserves the larynx in about two thirds of patients without compromising survival.

Why is "Observation only" not the answer?

Observation leaves the tumour untreated.

Why is "Immediate total laryngectomy" not the answer?

Immediate laryngectomy defeats the purpose of preservation.

Why is "Repeat chemotherapy for 1 year" not the answer?

Prolonged chemotherapy alone is not curative.

What concept does this question test?

It tests Head and neck tumours: larynx preservation by induction chemotherapy in ENT. Poor responders undergo laryngectomy. Concurrent chemoradiotherapy is now the usual alternative.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck tumours: larynx preservation by induction chemotherapy?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.