Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Soft Tissue sarcoma > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

What are the acute toxicities of RT?

A

Dermatitis

Epilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the long term complications of RT?

A

Weakening of bone, 18 months is greatest risk of fracture
Fibrosis leading to loss of range of motion
Lymphedema
Skin discoloration
Telangietasia
2nd cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long after surgery should PORT be given?

A

3-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What dose should be delivered post-operatively?

A
  1. PTV 1: 50 Gy at 2 Gy/fx
  2. PTV 2: Boost to 60-66 (10-16 Gy) at 2 Gy/fx for R1

or

  1. PTV 2: Boost to 70 to 76 Gy at 2 Gy/fx for R2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What dose is recommended preoperatively?

A

50 Gy at 2 Gy/fx to one volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are outcomes after RT alone?

A

LR is 66% and 2 year DFS is 17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What patients can get surgery alone?

A

Low grade soft tissue sarcomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the advantages of preop RT vs. post-op RT?

A
  1. Lower RT dose
  2. Smaller RT fields
  3. Better resectability
  4. Better oxygenation of tumor cells
  5. Fewer long-term toxicities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the recommended follow up after surgery and RT for STS?

A
  1. Follow up and Chest CT every 3 months for 2 years
  2. Follow up every 6 months for 3 years with Chest CT
  3. Follow up yearly

MRI of the primary every 6 months for 2 years

Occupational and physical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the likelihood of local control after RT+ surgery?

A

> 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the most common sites?

A

Extremity: 60%
Trunk: 30%
Head and neck: 10-15%

Retroperitoneum: 10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What elements of the history and physical should be inquired about on exam?

A

History: history of palpable mass, pain, weakness, numbness, changes in range of motion edema of extremity,

Physical exam: palpation of the mass, lymph node exam, range of motion, strength, sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the most common histologues of STS?

A
  1. High-grade undifferentiated pleomorphic sarcoma (20-30%)
  2. Liposarcoma (10-20%)
  3. Leiomyosarcoma (5-10%)
  4. Synovial sarcoma (5-10%)
  5. Malignant peripheral nerve sheath tumors (5-10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T1

A

5 cm or less
T1a: superficial to superficial fascia
T1b: Deep to superficial fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T2

A

> 5 cm
T1a: superficial to superficial fascia
T1b: Deep to superficial fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

N1

A

Regional nodes

17
Q

M1

A

Distant metastatic disease

18
Q

What is the grading system?

A

French 3 grade system based on
Differentiation: 1-3
Mitotic index: 1-3
Necrosis: 0-2

Grade 1: 2-3
Grade 2: 4-5
Grade 3: 6-8

19
Q

Stage I

A

IA: T1ab N0 Grade 1
IB: T2ab N0 Grade 1

20
Q

Stage II

A

IIA: T1ab Grade 2-3
IIB: T2ab grade 2

21
Q

Stage III

A

T2ab N0 Grade 3

Any T N1 M0, Any grade

22
Q

Stage IV

A

M1

23
Q

What imaging and labs are needed at work up?

A

Imaging: CT scan with contrast and MR of the primary tumor. CT scan of the chest.

Labs: CBC, CMP

24
Q

How should these tumors be biopsied?

A

Incisional biopsy, vertical orientation

25
Q

What 5 factors are associated with an increased risk of DM?

A
  1. Deep tumor
  2. High grade
  3. > 5 cm
  4. Recurrent disease
  5. Leiomyosarcoma
26
Q

How to defined RT volumes with preop RT?

A

GTV= tumor volume on contrast enhanced MRI (not T2 edema)

CTV = GTV + 3 cm longitudinal margins and 1.5 cm radial margin

Edit CTV for anatomical boundaries including adjacent bones, and fascia unless these structures are involved or have been violated

PTV=CTV + 1 cm

27
Q

How to defined initial RT volumes with post-op RT?

A

GTV: presurgical tumor volume + post-op bed
CTV= GTV + clips+drain sites+scar and use 1.5 cm radial margin and 4 cm longitudinal margin
PTV=CTV + 1 cm

28
Q

How to defined boost RT volume with post-op RT?

A

GTV = predurgical tumor volume + post-op bed
CTV=GTV+1.5 cm radially, 2 cm longitudinally
PTV=CTV+1 cm

29
Q

What are subacute toxicites after RT and surgery?

A

Wound complications: 5-15% with PORT and 25-35% with preop

30
Q

What study supports preop RT?

A

Osullivan RCT

31
Q

What is the downside of preop RT?

A

34% risk of wound healing complications

Soft Tissue sarcoma (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions