Palliative RT

Question 1

what is the issue with size of trt volume

Answer 1

GTV, CTV, PTV not usually defined
adequate margins, organ movement, set up margins
areas defined by pt need

Question 2

what is the issue of the complexity of trt

Answer 2

pragmatic approach
imaging areas which need to be traa was ted
osteolytic + sclerotic lesions

Question 3

issue with accessory set up

Answer 3

pt comfortable
simple
immobilisation
appropriate
linac or kv equipment

Question 4

issues with pt care

Answer 4

analgesia
special care required
care would need to be site related
IP/OP
transport
family support
end of life

Question 5

what is given alongside brain met patients

Answer 5

corticosteroids

Question 6

what is the survival for corticosteroids alone

Answer 6

2 months

Question 7

brain met RT is given to what lesions

Answer 7

single or multiple deposits

Question 8

how long does WBRT lengthen life for

Answer 8

6 months

Question 9

is there a difference between WBRT and SRS

Answer 9

no survival difference

Question 10

what is SRS for

Answer 10

single or limited met deposits
improved local control with focal therapy - high dose with rapid fall off to normal tissue

Question 11

what is WBRT less likely to cause

Answer 11

neurological death (brain has lost its function)

Question 12

what machines offer SRS

Answer 12

gamma knife
cyber knife
gantry based linac with micro MLCs
PBT

Question 13

what is the SRS dose

Answer 13

16.2-25 Gy

Question 14

WBRT dose

Answer 14

30-40Gy in 15-20# in 3-4 wks

Question 15

what treatment is given got aggressive disease

Answer 15

surgery, post op RT, chemo

Question 16

what high grade gliomas are treated

Answer 16

anaplastic astrocytoma and GBM

Question 17

what is the survival for surgery alone with brain mets

Answer 17

6 months

Question 18

what is surgery and post op RT survival for AA and GBM

Answer 18

AA = 36 months
GBM = 9-10 months

Question 19

what is the survival for surgery, post op and chemo for AA and GBM

Answer 19

15% relative reduction in risk of death
AA = 37% 2 year survival
GBM = 9-13% 2 year survival

Question 20

what are the cranial SE

Answer 20

vasculature
- endothelial cell death
- blood vessel wall thickening
- vessel occulsion
glial cells useful
- cerebral atrophy
- cognitive defects

Question 21

WBRT TV

Answer 21

WB, olfactory groove and middle cranial fossa
inf border = supra orbital ridge and EAM
covers scalp 5mm margin

Question 22

what is the technique for WBRT

Answer 22

POP
isocentric fixed FSD
6MV

Question 23

what is the dose for WBRT

Answer 23

30Gy in 10
30-40Gy in 15-20
20Gy in 5
12Gy in 2 over a week

Question 24

what would a pt need that has multiple bone mets

Answer 24

a field match

Question 25

what is the TV of a bone met based on

Answer 25

pt symptoms

Question 26

what is the role of RT for bone mets

Answer 26

control pain prevent pathological fractures

Question 27

what should be treated/avoided in RT for bone mets

Answer 27

whole bone/structure should be treated (vertebrae, hemipelvis) intervertebral discs) channel of normal tissue (preserve lymphatic drainage) joint spaces should be avoided

Question 28

what happens to bone due to osteolytic lesions

Answer 28

they replace normal bone with a blast portion showing a lower attenuation with the normal cancellous bone, this comprises lesions with fatty liquid and solid soft tissue components

Question 29

what is the characteristics of a bone met

Answer 29

matrix mineralisation, osteoid, chondroid, fibrous septations and trabeculations moth eaten margin types: sclerotic, well defined, poorly defined or indistinct described as wide or narrow zone of transition cortical involvement: cortical expansion, cortical destruction periosteal reaction: benign or aggressive

Question 30

what is the RT for local bone pain

Answer 30

single direct or POP 300kv @ 3cm depth SC depth to body is 5-8cm 8Gy in 1 however alternatives are 20Gy in 5 or 30Gy in 10

Question 31

what is the post op RT for bone mets

Answer 31

for pt with longer prognosis 8Gy in 1, 20Gy in 5 or 30Gy in 10 lymphatic channel margin TV is not clear either whole bone or prosthesis and a margin for micro mets (3cm)

Question 32

what is the sup borders for hemibody irradiation

Answer 32

top of scalp - umbilicus or chin (extended) - umbilicus

Question 33

what is the inf borders for hemi body irradiation

Answer 33

umbilicus - soles of feet

Question 34

RT field hemibody iradiation

Answer 34

field: 4cm or extended FSD field matching due to divergent beams

Question 35

doses for hemibody

Answer 35

8Gy in 1 20Gy in 5 30Gy in 10

Question 36

what is the gap between the different fields for hemibody

Answer 36

6 weeks

Question 37

what is the max lung dose for hemibody

Answer 37

6Gy

Question 38

what are the considerations for hemibody

Answer 38

QoL and co-morbidities travel RT outcome single exposure might be preferred possibility of path fracture

Question 39

what is the aetiology for bladder cancer - palliative

Answer 39

70+ smoking poor health co-morbidities: muscle invasive bladder cancer

Question 40

what is the trt for bladder cancer

Answer 40

surgery or chemo if not suitable for chemo then RT

Question 41

indications for RT for bladder cancer

Answer 41

haematuria: heavy bleeding, clots urinary symptoms local pain

Question 42

what is the RT volume for bladder cancer

Answer 42

empty bladder minimal volume CT sim location

Question 43

what is the potential issues for bladder cancer

Answer 43

failure of treatment (30-40%) fistuala (uncommon) - vesico-vaginal - vesico - colic - vesico - rectal

Question 44

what are the doses which can be given for bladder cancer if they have 6 months or more.

Answer 44

21Gy in 3# over 5 days 35Gy in 10# over 12 days

Question 45

what are the doses given for pall bladder cancer pts with poor prognosis

Answer 45

17Gy in 2# over 3 days 14Gy in 4# once per month 8Gy in 1#

Question 46

what is the percentage reduction for haematuria in fractionated and conventional regimes

Answer 46

fractionated: 60-65% reduction conventional: 70%

Question 47

what does the primary for lung mets tend to be

Answer 47

breast colon prostate lung

Question 48

indications for RT for lung Mets

Answer 48

symptomatic with advanced disease 80% response with haemopytsis 60% response with chest pain 30% response with dyspnoea

Question 49

what is the immobilisation for lung Mets

Answer 49

non supine arms by side

Question 50

what is the volume for lung Mets

Answer 50

primary + nodes + 2cm margin

Question 51

what is the field for lung Mets

Answer 51

non complex POP (A+P) isocentric/fixed FSD complex iso technique = radical approach, palliative intent verification

Question 52

what are the doses for lung Mets

Answer 52

6MV 39Gy in 13# in 2.5 weeks 16Gy in 2# once a week 10Gy in 1 #

Question 53

what is the acute toxicity for cranial RT

Answer 53

cerebral oedema transient worsening of pre treatment symptoms required corticosteroids (dexamethasone 4mg) radiation dermatitis and permanent alopecia nausea and vomiting (antiemetics)