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Complex Issues in Radiotherapy > Paediatric Oncology - Brain + CNS > Flashcards

Paediatric Oncology - Brain + CNS Flashcards

(63 cards)

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1
Q

who is a child

A

a person under the age of 18

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2
Q

paediatric age

A

0-16

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3
Q

young person age

A

16-25

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4
Q

children + young adult age

A

0-25

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5
Q

peak age

A

0-4

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6
Q

how many cases every year

A

1,838

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7
Q

incidence increase since the early 1990s

A

12%

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8
Q

what is the five year survival rate

A

84%

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9
Q

risk factors

A

genetics [retinoblastoma RT1 NF2]
previous cancer trt
exposure to radiation
exposure to infection [EPV]
issues with development in the womb
medical conditions

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10
Q

what is NF1

A

skin pigmentation
multiple tumours along the spine
intellectual impairment
growth disorder

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11
Q

what effects are more prevalent

A

late

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12
Q

is there lower or greater tolerances

A

lower tolerances to RT - significant doses are needed + large field
combines RT with surgery/chemo as ++aggressive

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13
Q

what are the RT margins based off

A

diagnosis to prevent recurrence

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14
Q

whos involved in the care

A

SLT
surgeon
play therapists
play specialists
anathetises
neurologists
CNS
nurse specialist
physio
endocrinologist [for life]

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15
Q

what are the tests for a CNS cancer

A

MRI
CT
lumbar puncture
blood test
biopsy
tissue banking

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16
Q

why is tissue banking done

A

high risk of recurrence rates need to see if its from the original tumour genetics or a new primary

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17
Q

what are the tumour types

A

glial cells
embryonal cells

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18
Q

what are the glial cell types

A

astrocytoma
ependymoma
oligodendroglioma

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19
Q

what are the embryonal cell types

A

medulloblastoma
PNET [primitive neuro]

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20
Q

what category are they placed in

A

cat 1

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21
Q

how are they graded

A

using the WHO classification

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22
Q

high grade

A

fast growing
agressive
likely to infiltrate into brain tissue, damage the surrounding areas

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23
Q

symptoms

A

change in head circumference
seizures/fits
loss of balance/coordination
walking problems [dysmetria/ chorea]
abnormal eye movements
learning difficulties
sight issues [loss of vision or double vision]
behaviour changes
persistent vomiting
current headaches
abnormal head position: wry neck+ stiff head or neck

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24
Q

what is the most common type

A

astrocytoma

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25
what is a focal astro
clear boundaries between tumour and brain tissue
26
what is a diffuse astro
filter out into the brain can't distinguish between the tissue
27
what can surgery be used for
low grades all tissue is removed
28
what is the trt for high astro
+/- targeted cancer therapy [bevauizamab]
29
what is the dose for an astro
54Gy in 30
30
when is chemo given over RT
for under 2 until they are grown enough for RT
31
what is the SIIOP II trial for ependymoma
chemo and extended RT
32
what is the trt for ependymoma
surgery and RT
33
if the ependymoma tumour is localised what can be given
PBT - 42 days [28 ideal]
34
what is the RT regime for ependymoma
phase 1: whole CNS 36Gy in 20 (>3) 25Gy in 20 (<3) phase 2: tumour bed boost + boost to met sites up to 59.4Gy in 33 (50.4Gy for spinal mets)
35
what do we need to know about HGG
biological markers
36
what is the regime for HGG dependent on
stage, age at time of RT
37
chemo for HGG
vincristine, cyclophosphamide, methotextrate
38
what treatment is given for HGG
surgery [as much as a complete resection as possible], chemo, RT
39
what are the different types of HGG
IDH wildetype, H3 wildetype, diffuse type, e.g diffuse hemispheric glioma H3 G34 mutant
40
when should post-op RT for HGG be?
no later than 4-6 wks for post maximal safe resection
41
what is the dose for HGG
54-59.4Gy
42
can you give more than one fraction a day for a HGG
NO slow cell growth, slow radiobiology
43
describe the GTV, CTV, PTV for the HGG
GTV: resection cavity and residual CTV: GTV + 1.5-2cm margin PTV: 3-5mm margin expansion
44
where are the craniopharyngioma's found
in the pituitary
45
how do pt with craniopharyngioma present
personality changes
46
what is the trt for craniopharyngioma
surgery + RT [ideally protons]
47
what are the doses which can be given for craniopharyngioma
50.4Gy in 28 54Gy in 30 50Gy in 25
48
who will pt see if they have a craniopharyngioma
endocrinologist, might need HRT
49
give me information on choroid plexus carcinoma
highly vascular lesion median age: 2 years chemo often to delay RT
50
what is the chemo given for choroid plexus carcinoma
etoposide, carbo-platin, cyclophosphamide
51
where does a medulloblastoma originate from
post fossar cerebellum which are undeveloped brain cells which become malignant
52
where is a PNET found
anywhere else
53
how can you identify a medulloblastoma or PNET
biological mark up
54
what is the trt for a medulloblastoma
surgery, chemo and RT very aggressive tumour eventhough it is radiosensitive
55
what is the trt for a standard risk patient with a medulloblastoma or PNET
standard chemo + RT
56
what is the trt for a low risk patient with a medulloblastoma or PNET
lower dose
57
what are the subgroups of medulloblastoma or PNET
group 3 (41%) sonic hedgehog (41%) group 4 (17%)
58
what are medulloblastoma/PNET split into two phases
radiosensitive but very aggressive might start to metastases tend to be in the high risk category so boost prevents recurrence high met spread (including to the spine)
59
what is the two phase doses for medulloblastoma/PNET
phase 1: 23.4Gy in 13 (whole CNS) phase 2: bed boost 30.6Gy in 17 whole CNS due to high chance of met spread
60
what is intracranial germ cell
germ cells which are left behind with development issues in the womb relapse tends to occur in ventricles
61
what is the trt for intracranial germ cell
surgery and chemo
62
what is mengioma
it is a tumour found in the meninges which uses complex field shapes when treating
63
what are the OARS
ovaries kidneys BS (<54Gy) optic chiasm lung cochlea parotid gland pituitary gland heart testes

Complex Issues in Radiotherapy (12 decks)

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