Session 2 Review_Radiation and SCLC

Question 1

What is external beam radiation therapy (EBRT)?

Answer 1

Uses a beam of photons or electrons to kill tissues, typically administered over several days.

Question 2

What is stereotactic radiosurgery (SRS)?

Answer 2

Type of EBRT: Full calculated dose of radiation delivered in one fraction, typically for small tumors.

Typically to brain, spine

Question 3

What is stereotactic body radiation therapy (SBRT)?

Answer 3

Type of EBRT: 2-5 fractions of highly precise radiation usually to spine, lung, prostate, pancreas, liver - able to give a higher dose of radiation in a shorter period of time.

Question 4

What is brachytherapy?

Answer 4

Radiation source placed inside or next to the area. Can be low dose or high dose. Helps to focus radiation around the tumor cells and spare healthy cells because it only travels short distances.

Question 5

List the indications for radiation therapy.

Answer 5

Symptom management, Neoadjuvant therapy, Adjuvant Therapy, Definitive (Curative) therapy.

Question 6

List the different types of radiation therapy.

Answer 6

External Beam Radiation Therapy, Brachytherapy, Intraoperative Radiotherapy, Targeted Radionuclide Therapy.

Question 7

What is fractionation?

Answer 7

Each dose of radiation delivered, a fraction of the total dose delivered over time.

Example: 5 Fractions (Fx) of 2 Gray (Gy) = 10 total Gy.

Question 8

What wavelengths are used in radiation therapy?

Answer 8

Xray, Gamma Rays.

Question 9

What are the types of External Beam Radiotherapy (EBRT)?

Answer 9

3D-CRT, 4D-CRT, IMRT, VMAT, SRS, SBRT, WBRT.

Question 10

How long are patient visits, typically, for their radiation therapy?

Answer 10

15-30 minutes.

Question 11

What is hypofractionation?

Answer 11

Less fractions than standard.

Question 12

What is hyperfractionation?

Answer 12

More fractions than standard.

Question 13

What does Gy stand for?

Answer 13

Gray: unit of radiation delivered.

Question 14

What is the median overall survival for patients with extensive stage small cell lung cancer treated with chemotherapy?

Answer 14

10.5 months.

Question 15

What is the median overall survival for patients with ES-SCLC treated with chemotherapy AND immunotherapy?

Answer 15

13 months.

Question 16

What does it mean to be radiosensitive?

Answer 16

Cancer that is highly susceptible to the radiation therapy (tumor cells can easily be killed by radiotherapy).

Question 17

What does it mean to be radioresistant?

Answer 17

Cancer that is resistant to radiation therapy (tumor cells not so easily killed by radiotherapy).

Question 18

What is Extensive Stage Small Cell Lung Cancer?

Answer 18

Advanced SCLC that has spread beyond one lung (hemithorax) and may include distant metastases, malignant pericardial or pleural effusions, and/or contralateral lymph node involvement.

Question 19

Why does Small Cell Lung Cancer have a poorer prognosis compared to non-small cell lung cancer?

Answer 19

Because, although SCLC is very responsive to chemotherapy and radiation initially, it very commonly recurs and subsequent treatments are not as effective. Essentially, lesser treatment options that prolong life. With the exception of newer data coming out related to BiTE therapy.

Question 20

What are the 4 most common side effects of platinum based chemotherapy?

Answer 20

Myelosuppression, Nausea, Neuropathy, Nephrotoxicity.

Question 21

What are the 4 most common acute side effects of IMRT (a type of EBRT) to the Head and Neck?

Answer 21

Mucositis, Skin toxicities (localized skin breakdown/burning/itchiness), Dysphagia, Hoarseness.

Question 22

What are common LATE side effects of IMRT (a type of EBRT) to the Head and Neck?

Answer 22

Xerostomia (dry mouth), Fibrosis, jaw trismus, pharyngeal dysfunction, Thyroid dysfunction, secondary cancers.

Question 23

When would you expect acute side effects to H&N radiation to start developing?

Answer 23

2-4 weeks after initiation of radiation.

Question 24

When would you expect acute side effects to H&N radiation to hit its peak?

Answer 24

Right at the completion of Radiation therapy.

Question 25

When would you expect acute side effects to H&N radiation to start getting better?

Answer 25

1-3 weeks after radiation is completed.

Question 26

For radiation to treat bone pain, when would you expect pain to improve?

Answer 26

2 weeks to 2 months later.

Question 27

In ES-SCLC, does WBRT for brain metastases prolong overall survival?

Answer 27

No.

Question 28

What is the most common side effect to WBRT?

Answer 28

Neurocognitive changes - short term memory processing.

Question 29

What is the most severe side effect to WBRT?

Answer 29

Radionecrosis.

Question 30

When would you expect WBRT side effects like neurocognitive changes to occur?

Answer 30

3-6 months after radiation is completed.

Question 31

Is neurocognitive changes from WBRT reversible?

Answer 31

No, if they occur, they will be long lasting - no treatments found to improve the symptoms after they show up.

Question 32

What is WBRT?

Answer 32

Whole Brain Radiation Therapy.

Question 33

What techniques can be done to decrease risk of WBRT side effects?

Answer 33

HA - WBRT + Prophylactic Memantine.

Question 34

Compare and Contrast Stereotactic Radiosurgery (SRS) and Gamma Knife Therapy.

Answer 34

They have the same goal - really narrowly target brain lesions in a way that puts high intensity radiation to the tumor and spares healthy tissue. They're different because they use different equipment.

Question 35

How are Radiation Therapy and Chemotherapy similar?

Answer 35

They are both cytotoxic, cell killing. They both canNOT differentiate between healthy tissue and cancerous tissue.

Question 36

How does Chemotherapy and Radiation therapy work together?

Answer 36

Chemotherapy can sensitize tissues to make radiation more effective at causing DNA strand breaks and killing the cancer tissues.

Question 37

Why does radiation get delivered over multiple fractions (doses) typically?

Answer 37

To give healthy tissues time to heal and repair itself.

Question 38

Is Small Cell Lung cancer considered radiosensitive or radioresistant?

Answer 38

Radiosensitive.

Question 39

Is Melanoma considered radiosensitive or radioresistant?

Answer 39

Radioresistant.

Question 40

After initial response to treatment, if a patient experiences relapse of their SCLC, what can they expect their prognosis to be, even with treatment?

Answer 40

2-6 months.

Question 41

If a patient with SCLC has response to treatment, if they're going to have relapse of their disease, within what time frame can they expect that to occur?

Answer 41

within 2 years.

Question 42

What can patients expect their prognosis to be if they have ES-SCLC WITH Brain metastases?

Answer 42

It is shorter than average, could be as short as 6 months even with treatment.

Question 43

What is HA-WBRT?

Answer 43

Hippocampal Avoidant - Whole Brain Radiation Therapy. A technique to decrease risk of neurocognitive side effects with WBRT.

Question 44

When might WBRT generally be considered to increase overall survival?

Answer 44

When a patient's prognosis is primarily being driven by intracranial disease not amenable to SRS.

Question 45

When might WBRT be useful for symptom management even if it won't improve overall survival?

Answer 45

When current symptoms from tumor/cerebral edema such as intractable seizures or headaches outweigh the side effects of short term memory processing changes.

Question 46

What are the advantages of using 3D-CRT for painful spinal metastases?

Answer 46

Can be done quickly and urgently. Can be as short as 1 fraction.

Question 47

What are the disadvantages of using 3D-CRT for painful spinal metastases?

Answer 47

Does not sculpt away the vital tissues around the spine, so more healthy tissue impacted.