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2B treatment summaries Flashcards

1
Q

Anal T1N0
Dose & volumes

A

T1N0
50.4Gy/28#
No elective nodal volume

GTV - Gross primary anal tumour
CTV - GTV + 1cm
Cover Anal canal, verge, internal and external anal sphincters.
Edit from bone & muscle.

PTV-P = CTV +10mm

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2
Q

Anal T2N0
Dose & volumes

A

T2 (<4cm) N0:
50.4Gy/28# to anal tumour
40Gy/28# to elective nodal volume
GTV-A = primary tumour
CTV A = GTV +10mm, entire anal canal & internal and external sphincters

Elective volume = from bifurcation of common iliac vessles (L5/S1) or 1.5cm above GTV
incl inguinal, femoral, int & ext iliac, obturator, pre-sacral nodes and perirectal nodes.
Include lower 5cm of the mesorectum, or whole mesorectum if tumour extends into it
Include ischiorectal fossa if >5mm infiltration outside levators, puborectalis muscle, external anal sphincter or anal verge, or into the ischiorectal fossa either clinically or on diagnostic imaging, or if skin involvement

PTV-P = CTV +10mm
PTV -elective = 5mm

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3
Q

Anal T2 >4cm, T3-4 / N+
Dose & volumes

A

T3-4 (&T2 >4cm) or N+:
53.2Gy/28# to primary tumour and nodes >3cm, 50.4Gy to positive nodes <3cm
40Gy to elective volume

GTV-P = primary tumour; CTV-P = GTV +15mm;
PTV-P = 10mm
GTV-N = positive nodes; CTV-N = GTV +5mm;
PTV-N = CTV+5mm

Elective volume = from 2cm above SI joint (L5/S1) or 1.5cm above GTV, inguinal, femoral, int & ext iliac, obturator, pre-sacral nodes and perirectal nodes, but not including mesorectal nodes.
Include lower 5cm of the mesorectum, or whole mesorectum if tumour extends into it
Include ischiorectal fossa if >5mm infiltration outside levators

PTV-P = CTV +10mm
PTV-N & -elective = 5mm

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4
Q

Anal - adj treatment

A

Indication: close or positive margin and no further resection possible
41.4Gy in 23# - Cover scar plus 1cm margin with MMC & Capecitabine
Include elective nodal volume if primary ≥T2 (similar to treating primary)

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5
Q

Breast - whole breast field borders

A

Whole breast - borders:
1.5cm into lung, 1cm anterior clearance
midline to mid axillary line
1cm below breast tissue (or inferior aspect of medial head of clavicle) to 1cm above breast tissue

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6
Q

Breast - axilla field borders

A

Axilla - 5-7° couch twist, single isocentre technique; borders:
Lateral border of humeral head
Med - 1cm lateral to midline
Sup - 3cm above clavicle
Inf - match to whole breast tangent, half beam blocked

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7
Q

Breast - SCF field borders

A

SCF - borders:
(Humeral head shielding unless treating axilla)
Lateral: 2/3 along clavicle
Med - 1cm lateral to midline
sup - 3cm above clavicle
Inf - matched to whole breast, 0.5cm below clavicular head

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8
Q

Breast - partial breast

A

Indications: >50 & low risk

Partial breast - Tumour bed +15mm; cropped 5mm of skin and chest wall
PTV 10mm, respecting 5mm from skin but unmodified posteriorly

Covered with tangential fields

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9
Q

Breast - boost

A

Indications: all <50, >50 & high risk (G3, LVSI+, N+, HER2+)

Boost:
CTV = tumour bed & clips, not grown for CTV, and wired scar
PTV = 5mm

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10
Q

Breast - chest wall

A

Indication: T3-4, N2, high risk N1, positive margins, residual disease after NACT
Chest wall - wire scar, include skin flaps & entire scar, underlying muscle and ribcage

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11
Q

Breast - whole breast and int mammary nodes

A

IMN (whole breast and IMN by IMRT):
Ant - 5mm from skin
Post - deep fascia
Inf - breast tissue
Sup - inferior medial clavicular head
Med - ipsilateral edge of sternum
Lat - thoracic vessels or breast tissue
PTV = 5mm

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12
Q

Breast - int mammary vessels

A

Int mammary vessels from where artery comes off subclavian artery, for first 3 ribspaces (node negative) or first 5 (IMN node positive)
CTV = 5mm, clipped from lung edge
PTV = 5mm

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13
Q

Bladder

A

55Gy/20#
CTV = whole bladder + 1cm (F) / 1.5cm (M) of urethra if base of bladder involvement
PTV = 1.5cm (2cm if dome of bladder)

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14
Q

Cervix

A

Ph1: 45Gy/25#
Ph2: 20Gy/10# EBRT boost or 21-28Gy/3-4# by IGBT

1° CRT:
GTVp = macroscopic disease on fused MRI
HR-CTV = remaining cervix
LR-CTV = CTV-HR, bilateral parametria, uterus, prox 2cm of vagina or 2cm below disease, uterosacral ligaments (& mesorectum if uterosacral ligaments involved)
ITV45 = LR-CTV + 10mm ant/post, 10mm sup/inf & 5mm laterally, and elective nodal volume
Elective nodal volume - from L5/S1 for common iliacs, and renal vessels for para-aortics - CI, II, EI, PS, O

GTV-N = positive nodes; CTV-N = GTV-N +5mm
PTV = ITV +5mm

Ph2 boost - GTVp +2cm

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15
Q

Chordoma

A

70Gy
Protons
Include whole clivus & vertebral body if affected

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16
Q

CNS - Glioma

A

Glioma
CTV = GTV +1.5cm for low and high grade
High grade planned on T1 post contrast
Low grade planned on T2
Temporal lobe lesion - include whole temporal lobe
PTV = 3mm margin

60/30
40/15
59.4/33
54/30
30/6
35/10 for re-irradiation

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17
Q

CNS lymphoma

A

CNS lymphoma
4x matrix then WBRT (if not for SCT) - 36/20 +/- 9Gy boost for partial response; Shield lens and anterior chamber after 36Gy
CR after chemo - 23.4/13#
GTV = residual tumour post chemo, CTV = 2cm, PTV = 3mm

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18
Q

Haem - 1° testicular lymphoma

A

1° testicular lymphoma - 30Gy/15# to contralateral testis

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19
Q

Meningioma

A

Adj RT - 54/30; GTV = residual tumour and reconstructed pre-op imaging for contact points of tumour. CTV = 1cm along the dura; PTV = 3mm

Radical - Gr1 - 50/30; Gr2 - 55/33; Gr3 - 60/30
GTV = primary tumour; CTV = 1cm along dura (2cm if Gr 3); PTV = 3mm

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20
Q

Haem - marginal zone

A

Marginal zone - 24Gy/12# to whole stomach, fasted for reproducibility
CTV = whole stomach +1cm and include perigastric nodes
PTV = 1cm

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21
Q

Haem - NK/T cell lymphoma

A

NK/T cell lymphoma - gelox x2 then 50/25 then Gelox x2
CTV = GTV + whole nasal cavity, maxillary antra and 1-2cm beyond

22
Q

Haem - mycosis fungoides

A

Mycosis fungoides - 8Gy/2#, electrons treated to 1cm depth; PTV = 1cm

23
Q

Haem - solitary plasmacytoma

A

solitary plasmacytoma: 45Gy/25# if <5cm; 50Gy/25# if >5cm

CTV = whole vertebra and soft tissue, +2cm extension
Adjuvant CTV = GTV +10mm and include metalwork
PTV = 5mm

H&N SEP - GTV = primary + nodes; CTV = 15mm; PTV 10mm

24
Q

haem - conjunctival lymphoma

A

Conjunctival lymphoma - 24Gy/12#
CTV is whole conjunctiva with lead contact lens for shielding. 300kV photons
If posterior orbit lesion - 30/15 planned photons prescribed to midplane

25
haem - Hodgkin's lymphoma
CTV = Whole nodal compartment radially, +1.5cm sup/inf PTV = 5mm
26
Primary testicular lymphoma - contralateral scrotal RT
9MeV electrons, with bolus Scrotum on a block, penis taped up 30Gy/15# Frog leg position
27
Endometrium - adjuvant treatment
Post TAH/BSO 45/25Gy +/- 7Gy single fraction dobbie if cervical invasion CTV1 (Tumour bed) Whole Parametrium and 2.5cm upper vagina CTV2 (nodes) From bifurcation of common iliac - internal iliac, ext iliac, obturator and pre-sacral nodes. Cover one nodal level above those involved PTV1 - CTV1 + 10mm PTV2 -  CTV2 + 8mm
28
Lung - SCLC
Small cell: Concurrent - 45Gy/30#/3wks +cis(60)/etopo(100 IV d1, 200mg PO D2-3) starting C1 Seq - cis(80)/etopo(100 & 200) x4 followed by 40Gy/15#/3wks 4D planned - GTV is post chemo primary and pre-chemo LN in all phases of respiration and grown by 5mm to form ITV; PTV = 5mm PCI = 25Gy/10# within 4-6wks
29
Lung - NSCLC
NSCLC: 55Gy/20#/4wks +cis(80)/vinorelbine(15mg - D1 & 8) starting C2 4D planned - GTV is post chemo primary and pre-chemo LN in all phases of respiration and grown by 5mm to form ITV; PTV = 5mm SABR - 54/3; 55/5; 60/8 4D planned - GTV = ITV; PTV = 5mm
30
Parotid
Sup: zygomatic arch Inf: hyoid bone Ant border of masseter to mastoid
31
Pituitary
Pituitary 45/25 or 54/30 if functioning GTV = tumour; CTV = pituitary fossa; PTV = 3-5mm
32
craniopharyngioma
Craniopharyngioma 1° & adjuvant - 54/30 GTV = residual mass + reconstructed primary; CTV = 5mm, including all areas contacted by tumour PTV = 3mm
33
Rectum
LC-CRT - 45/25 +/- 5Gy SIB (GTV +2cm) SC = 25/5/5 days GTVp = gross tumour or whole lumen ICTVp = GTV+10mm (15mm anteriorly for high rectal tumours) GTVn = positive nodes; ICTVn = 5mm margin ICTV elective = mesorectum +1cm anteriorly (starts at S2/3 or bifurcation of the IMA), or 2cm above most positive node, & nodal volume (int iliac, presacral, obturator) ICTV = ICTVp + ICTVn +ICTV elective Edit off bone and muscle, but not off the sacrum, and edited off muscle but not obturator internus if obturator node positive PTV = 10mm margin
34
H&N - nasopharynx
70-63-57 T1-2: CTV70 = GTV +5mm; CTV-63 = GTV +10mm, entire nasopharynx T3-4: CTV70 = GTV +5mm; CTV-63 = GTV +10mm, entire nasopharynx Adjuvant - reconstruct GTV & grow by 1-2cm
35
H&N - non-nasopharynx
CTV-65 = GTV+5mm (10mm if poorly defined) CTV-60 = GTV+10mm CTVn = GTVn +5mm (10mm if >3cm or local invasion & include whole muscle) PTV 3-5mm
36
prostate
60/20, 48/20 to SV, 44/20 to nodes CTV = prostate + prox 2cm of SV if ≤T3a, whole SV if T3b PTVp = 5mm; PTVsv = 10mm
37
prostate bed
Prostate bed: 52.5Gy/20# Vol - below SP: whole bladder to 8mm below VUA / 5mm above penile bulb Above SP: posterior 1/3 of bladder for 3cm above SP +SV volume PTV = 1cm
38
Penile
Penis: CTV = GTV +2cm & 20Gy/10 boost to primary and positive nodes Treating POP with wax block No PTV expansion Elective volume, inguinal and pelvic nodes; and involved nodes
39
Pancreas
40/5 SABR following folfirinox GTV primary + nodes 4D planned, ITV = GTV in all phases PTV = 5mm
40
Oesophagus
NA - 41.4/23 with carboplatin AUC2 & paclitaxel 50 Definitive - 50/25 - cisplatin (75) / 5FU (1000) starting C2-3 50Gy/16# - <5cm 55Gy/20# - >5cm
41
Thymoma - primary tx
Radical RT - 60/30 CTV = GTV +10mm; Ptv = 10mm
42
Thymoma - Adj
Adj RT if macroscopic invasion of mediastinum (st 2b) or high grade 45Gy/25# (R0) or 50.4/28 (R1) +/- boost to 60Gy GTV = surgical bed, CTV = 5mm, PTV = 5mm radially and 8mm sup/inf
43
Testicular
IGCN - 20Gy/10# to contralateral testis Stage 1 if no carboplatin given - 20Gy/10# - 30Gy/15# to PA strip, T11-L5, out to transverse process and include ipsilateral renal hilum. dog leg to mid obturator fossa if prev inguinal surgery. Shield remaining testicle AP/PA field based prescribed to mid plane
44
Stomach
R1 resection 45Gy/25#- CTV is tumour bed + residual PTV = 1cm
45
Skin - Merkel
Merkel - 60/30, of adj 50/25 (if positive margin, >2cm or node positive)
46
Sarcoma
Wire lump or scar Neoadjuvant - 50/25, 3cm sup/inf and 2cm radially Adjvant - 60-66/30-33; 50/25 then 10-16/5-8#, ph1 grown by 5cm sup/inf & 2cm radially, phase 2 by 2cm all round
47
vulva - primary
45/25 to elective nodal volume & GTV +1cm SIB to primary and positive nodes to 60Gy, or Ph2 EBRT 20/10 boost CTVn = GTVn +3mm PTV 3mm
48
vulva - adj
Adjuvant = scar +1cm, remaining vulva, mons and elective nodes
49
thyroid
65 (macroscopic disease)/60/54/30# GTV = residual tumour + positive nodes CTV = 1cm and thyroid bed Hyoid to sternal notch, laterally to carotid sheaths tracheo-oesophageal groove to front of vertebral body CTV54 = bilat level 2-6
50

FRCR2 (38 decks)

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