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Flashcards in Paediatric Deck (27):
1

How is treating a paediatric patient different from an adult?

- consider parents
- kids dont understand
- different dose limits and secondary malignancies
- tumour types different
- kids more at risk of late side effects
neurocognitive effects
- muscle developement

2

What are the symptoms of medulloblastoma? (8)

- headaches
- nausea and vomitting in the morning
- problems with motor skills (clumsiness or poor handwriting)
- tiredness
- tilting of head to one side
- walking difficulty and balance problems
- back pain
- inability to control bladder and bowel

3

How do you diagnosis medulloblastoma?

- symptom history
- MRI with and without contrast
- lumbar puncture (to see if tumour has progressed down CNS)
- surgery/biopsy
- pathology report

4

What is the classification of high risk Medulloblastoma?

- <3 yrs at diagnosis
- tumour remaining following surgery is more than 1.5cm^2
- M1-4

5

What is M0-M4 classification of Medulloblastoma?

M0 - no evidence of mets
M1 - tumour cells in the spinal fluid
M2 - tumour spread within the brain
M3 - tumour has spread to the spine
M4 - tumour has spread away from brain or spine

6

What are the survival rates of Medulloblastoma?

- M0- 70-80%
- if disease has spread to spinal cord, SR 60%
- children under 3 often lower SR due to more aggressive disease

7

Who is involved in a paediatrics multi-disciplinary team?

- occupational therapists
- physiotherapists
- medical oncologists
- paediatric nurses
- GA team
- RT
- Dieticians
- Speech pathologists
- teacher

8

What is play therapy?

- play-based procedural support and preparation refers to a specific child life intervention that aims to promote the child's coping with new and unfamiliar medical experiences

9

What does RT play therapy involve?

- delivery a social story by the OT
- practice making a mask and vacbag on toy or parent
- playing in the treatment room including using the controls
- watching parents on the monitor from outside the treatment room
- practice leaving the child in the room by themselves

10

What type of child is likely to require GA?

- children under 3
- behavioural issues
- compliance issue due to condition (e.g. posterior fossa syndrome)

11

What is posterior fossa syndrome?

- most commonly from surgery for posterior fossa tumours in paeds
- occurs in 8-24% cases
- absence of reduction in speech
- axial hypotonia and ataxia
- mild to completely disabling symptoms

12

What is GA is not an option?

- get the child to be very hungry then feed and then will fall into a deep sleep and then set up with straps

13

What was the old RT method of treating CNS?

- prone
- lateral skull fields
- single post spinal fields
- moving junction

14

What is the CT set-up of a CNS?

- supine
- full shell (mask)
- vacbag from head to pelvis
- knee bolster
- footstocks

15

What are some anatomical considerations when setting up a CNS?

- head tilt in neutral position with VBL = ITN to colmella
- spine straight and level
- arms are slighly anterior to spine
- shoulders should be level and relaxed inferil=oly
- no nappy as it effects pelvic tilt

16

Should paediatrics receive tattoos?

- prefer not as it is a traumatic reminder of experience
- can use point guards instead
- take a lot of measurements from landmarks

17

What is the prescription for low-risk Stratum W1?

- 15Gy/13# with boost up to 51Gy/30#

18

What is the prescription for standard-risk Stratum W2, S1, N1, N2?

- CSI 23.4Gy + cumulative primary site dose of 54Gy/30#

19

What is the prescription for high-risk Stratum W3, S2, N3?

- CSI 36-39.6Gy + cumulative primary site dose of 54Gy/30#

20

What are the treatment fields?

- 2x skull
- 2x upper spine
- 2x lower spine

21

Why is the whole spine treated with equal dose?

- to decrease the risk of abnormal growth by separate sections of the same vertebre causing serious back issues

22

What are some CSI planning challenges?

- treatment must start 36 days from surgery
- challenging and time consuming plan
- numerous challenging objectives for the optimiser

23

What is involved in the straightening and levelling of a CSI patient?

- length check from SSN to zifi and verify with marks on the bag

24

What image verification is needed?

- kV skull (0 action level)
- upper spine and lower spine (0.5mm action level)

25

What are the spine images orthoganals?

- to avoid irradiating the arms

26

What is the treatment process of CSI?

- image guidance 3 areas
- bed shift
- treat skull field
- bed shift
- treat upper spine
- bed shift
- treat lower spine
- post treatment CBCT if requested

27

What are the long term side effects of RT?

- neurocognitive and psychological
- cardioplumonary
- endocrine
- hearing loss
- musculoskeletal
- fertility
- second malignant cancer