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Thoracic Flashcards

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1
Q

SCLC covnentional lung constraints

A

V20<35%, V5<60%, Mean < 18 Gy

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2
Q

SCLC Conventional lung RT esophagus constraints

A

V60<30%, V50<50%, Mean < 34 Gy

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3
Q

SCLC Conventional lung Heart constraint

A

V30<50%, V50<25%, Mean < 26 Gy

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4
Q

Brachial plexus constraint, conventional lung

A

Max < 66 Gy

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5
Q

SCLC BID fractionation Lung constratins

A

V20<35%, Mean < 18 Gy

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6
Q

SCLC BID fractionation Lesophagus Constraint

A

Mean < 34 Gy

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7
Q

SCLC BID fract, heart constraints

A

V30<50%, V45<25%

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8
Q

Spinal cord constraint for BID frac

A

max 36 Gy ( 41 Gy)

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9
Q

define LS SCLC

A

disease that can be encompassed within a tolerable radiation port

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10
Q

Define ES SCLC

A

Extra thoraci disease or disease that cannot be encompassed

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11
Q

management of LS-SCLC

A

60 Gy in 30 vs 45 in 30 BID

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12
Q

PCI dose

A

25/10, discuss with LS-SCLC

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13
Q

management of ES-SCLC

A

Chemoimmunotherapy, carbo AUC=5 + etop + atezo then maintenance atezo

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14
Q

When to add consolidative lung RT in ES-SCLC

A

If patient had a PR, maybe even with CR. 30 Gy in 10 fx.

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15
Q

What paraneoplastic syndrome goes with thymoma

A

myasthenia gravis

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16
Q

Surgery for thymoma

A

open v robotic total thymectomy + LND

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17
Q

postop treatment for thymoma

A

chemo q3w CAP, cyclo, doxo, cisplatin

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18
Q

Masaoka staging for thymoma

A

I: grossly and microscopically completely encapsulated tumor, IIA: microscopic transcapsular invasion, IIB: Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through mediastinal pleura or pericardium, IIIA: macro invasion into pericardium or lung without great vessel invasion, IIIB: maco invasion into great vessel, IVA: pleural or pericardial implants, IVB: LN or DM

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19
Q

Management of localized thymoma

A

total thymectomy with complete tumor excision and anterior LND, R0: observe for stage I, PORT for stage II-IV, R1: PORT, R2: ChemoRT

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20
Q

Management of localized thymic carcinoma

A

total thymectomy with complete tumor excision and anterior LND, R0: observe for stage I, PORT for stage II-IV, R1: ChemoRT, R2: ChemoRT

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21
Q

Management of locally advanced thymoma or thymic carcinoma

A

Unresectable: CCRT, potentially resectable: CHT and restage, if resectable resect with PORT, if unresectable still: CCRT

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22
Q

Screening guidelines for lung cancer

A

recommended for 55-74 with 30+ pack year smoking history , current smoker or quit in past 15 yr, annual LDCT

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23
Q

FEV1 goal for pneumonectomy

A

> 2L or >80% predicted

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24
Q

FEV1 goal for lobectomy

A

> 1.5 L

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25
What do you want for predicted postop FEV1
>1L
26
What nodal groups can be assessed by cervical mediastinoscopy
2R, 2L, 4R, 4L, 7, 10R, 10L
27
What gives access to 5 and 6
Anterior mediastinoscopy
28
Describe contouring PBT
contour distal 2 cm trachea, carina, mainstem and lobar bronchi until site of segmental bifurcation
29
5 fractions spinal cord max
30 Gy
30
4 Fractiosn spinal cord max
26 Gy
31
4 fraction esophagus max
30 Gy
32
4 fraction heart max
34 Gy
33
4 fraction rib max
40 Gy
34
What is your goal CI for SBRT
<1.2
35
What is R50?
Ratio of 50% IDL/PTV Volume
36
What is your R50 goal
<5
37
Chemo for CCRT for NSCLC
Carbo AUC=2 and paclitaxel 50 weekly
38
When do you add RT in postop NSCLC
if positive margin not going back for re-resection (re-resection usually for earlier stages)
39
What do you give after CCRT for NSCLC
Durva for a year, 10 mg q2 weeks
40
When do you give chemo postop for NSCLC
any N+
41
Postop treatment for SCLC if N0
Chemo, then PCI
42
Postop treatment for SCLC if N+
CCRT, then PCI
43
cis etop dosing for SCLC concurrent
cis 75 on d1, etop 100 d1-3 (4-6 cycles) 21 day cycle
44
What immuno is used with ES-SCLC
Atezo or Durva
45
What surgery for SCLC that is N0
lobectomy with MLND
46
What consolidation immuno is used for SCLC
Durva
47
Atezo MOA
PDL-1
48
Durva MOA
PD-1
49
ES-SCLC chemo regimen
cis, etop, and durva concurrently followed by maintenance durva
50
What surgeries are used for mesothelioma
Pleurectomy and decortication for early disease, Extrapleural pneumonectomy for more advanced
51
Postop treatment after EPP for mesothelioma
R0: 50 Gy, R1: 60 Gy
52
Postop treatment after pleurectomy and decortication for mesothelioma
R0:45 Gy, R1: 54 Gy
53
After EPP, who are candidates for RT
ECOG<=1, good PFT, good kidney function, no disease in abd, contralateral chest, no supp O2
54
Contralateral lung mean for total pleural RT after mesothelioma
<8.5 Gy (could be fatal), V20<7%, can drop rx down to 40 Gy
55
ddx of anterior mediastinal mass
thymoma, thyroid, teratoma, lymphoma
56
Dose for PORT for thymoma
R0: 50 Gy, R1: 54 Gy, R2: 60 Gy
57
What biopsy is needed for suspected sarcoma
Longitudinal incisional bx along the plane of future resection, ideally done by the orthopedic oncologist that will resect.
58
T staging sarcoma of trunk and ext
T0: no evidence of primary tumor, T!: <=5 cm, T2: 5-10 cm, T3: 10-15 cm, T4: >15 cm
59
N staging sarcoma
N0: no LN, N1: LN+
60
preop sarcoma advantages
small field size, lower dose, treats oxygenated tumor, increases resectability -generally preferred
61
postop sarcoma advantages
Tailored to surgical findings, no delay in surgery.
62
Cons of Preop sarcoma RT
increases wound healing complecations 35% vs 15%
63
Cons of postop sarcoma RT
increased irreversible late fibrosis 50% vs 30%,
64
preop RT dose for sarcoma
50 Gy
65
Expansion for preop RT for sarcom
for low grade <8cm (2 cm sup inf and 1 radially, expand to 4 cm if needed to cover T2 signal) Use 3 and 1.5 for int or high grade or larger tumors
66
Postop dose for sarcoma
50 Gy to scar and drain sites, 60 Gy cone down, 66Gy for R1, 70 Gy for R2
67
CTV for postop sarcoma
4 cm sup inf and 1.5 cm radially to 50 Gy, conedown to surgical bed +2 cm(1.5 radially) for addiational 10-16 Gy
68
Constraint to weight bearing bone in sarcoma RT
V50Gy<50%
69
Constraint for stip of skin in sarcoma
V20<50%
70
Joint constraints for sarcoma
V50Gy<50%
71
Do you biopsy RP mass if going to surgery
no
72
CTV for RP sarcoma
1.5 cm isotropically including into muscle
73
Desmoid management
Resect, R0: observe, R!: re-resect vs RT vs obs, R2: definitive RT or systemic or obs
74
dosing for desmoid
R1: 50 Gy, R2: 56 Gy
75
GIST management
Surgery-->imatinib (no role for RT)
76
What is standard of care surgery for stage I NSCLC
Lobectomy, not wedge
77
Rate of esophagitis with BID frac for SCLC
78
What mean lung dose do you shoot for with mesothelioma radiation
Mean<8 Gy
79
What is postop RT dose for NSCLC if no gross disease
54 Gy
80
adjuvant therapy after srugery for NSCLC
if primary>4cm: chemo, if N1: adj chemo, if N2: chemo and consider RT 50.4 (54 for ECE), R1: reresection or CCRT 54 Gy
81
Staging mesothelioma
T1: ipsi parietal pleura with or without involvemnt of visceral pleura, T2: invasion of diaphragm or lung parenchym, T3: invasion of mediastinum, chest wall, pericardium, T4: diffuse multifocal chest wall, through mediastinal organs or pericardium,
82
Management of STage I-IIIA mesothelioma
Induction CHT cisplatin and pemetrexed then surgery or CHT if unresectable, if EPP performed needs hemithoracic RT
83
Management of STage IIIB or sarcomatoid mesothelioma
chemo vs best supportive care.
84
Dosing for hemithroacic RT for mesothelioma
R0: 50 Gy, R1: 54 Gy, R2: 60 Gy
85
Describe CTV for hemithoracic RT
ipsi pleural bed, ribs laterally, sternum anteriorly, VB posteriorly, diaphgramatic insertion inferiorly, add 5 mm PTV
86

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