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42 Cards in this Set
- Front
- Back
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RT (4 indications)
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metastatic, tumor site is inaccessible, tumor is not completely resected, tumor resumes symptoms after surgery
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Stereotactic-implants
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Allows for a delivery of a much higher dose while sparing the surrounding tissues
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Local Recurrence
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an increase in dose have been used in an attempt to increase survival.
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Stereotactic Radiosurgery
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produces prolonged survival when used as a boost, gives high radiation dose to a small volume, while sparing normal tissues.
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Radiosensitizers
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use of sensitizers makes the cells more susceptible to the radiation without increasing the radiation effects to the normal tissues.
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Altered Fractions
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hyperfractionation and accelerate hyperfractionation, which delivers smaller fraction doses two to three times a day to doses up to 82Gy.
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Low Grade Astrocytomas
tx fields |
Localized irradiation volumes 2-3 cm margin around contrast enhanced tumor (at tumor progression after MSR)
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Low Grade Astrocytomas
dose |
50-55Gy at 1.8-2.0/fx
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High Grade Astrocytomas
fields |
2 wedged pair arrangement flds w/ 2-3 cm margin around contrast enhanced tumor
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High Grade Astrocytomas
dose |
60 Gy at 1.8-2.0/fx; reduced portal after 50 if initial poral is large
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Medulloblastoma
tx fields |
Whole craniospinal fields are treated with a posterior fossa boost
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Medulloblastoma
dose |
Postop 30-36Gy to entire brain and spine; 20-25Gy tumor boost
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Pituitary tumors
tx fields |
Vertex and 2 laterals or arcs
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Pituitary tumors
dose |
45-50Gy in 1.8-2.0Gy
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Metastatic tumors
tx fields |
Whole brain
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Metastatic tumors
dose |
300cGy for 10 fractions
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Clinical detection
Brain |
Headache, solemence, intellectual defecits
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Clinical detection
Spine |
Parathesias, numbness, motor weakness
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time course of events
brain |
6-12mo. (brain necrosis and gliosis
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time course of events
spine |
Lhermitte’s syndrome 2-4 mo. after irradiation and persists or returns at 6-9 mo.; paresis, numbness and altered sphincter control at 6-12 mo.
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Dose/time/volume
brain |
50 Gy to WB in 1.8-2.0/fx; peds 30-35 Gy; TD5 50 (54)
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Dose/time/volume
spine |
45 Gy in 22-25fx; TD5 57-61, TD50 68-73
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Chemical/biological modifiers
brain |
Concomitant use of BCNU
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Chemical/biological modifiers
spine |
Intrathecal or IV use of concomitant methotrexate
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Management
brain |
Analgesics, antiseizure meds high dose coritcosteroids
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Management
spine |
IV corticosteroids
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Follow-up
brain |
Pt seen every day until relief is obtained
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Follow-up
spine |
Intensive nursing and rehab care
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Five pt concerns associated with CNS tumors
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Diet – food is unappealing—suggest small portions more frequently
Fatigue – too tired – suggest to nap and take it easy as necessary Permanent hair loss – suggest a wig or scarf provide tips for caring for the sensitive skin on the scalp Sun exposure – warn against direct exposure Sense of loss after tx ends – make a follow up call or two to reassure the pt |
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1 example in clinicals
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patient=whole brain. became extremely fatigued all the time and use to be a very active person. was concerned and wondered if it was normal to feel that tired
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Optic Nerve and chiasm
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astrocytoma
meningioma |
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third ventricle
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colloid cyst
astrocytoma ependymoma metastatic tumors |
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lateral ventricle
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ependymoma
meningioma choroid plexus papilloma subependymoma |
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cerebral hemisphere
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astrocytoma
glioblastoma oligodendroglioma meningioma sarcoma ependymoma metastatic tumors |
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pineal region
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germ cell tumors
pineal cell tumors meningioma |
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cerebellum
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astrocytoma
medulloblastoma hemangioblastoma metastatic tumors |
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fourth ventricle
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ependymoma
choroid plexus papilloma medulloblastoma |
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brain stem
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astrocytoma
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cerebellopontine angle
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acoustic schwannoma
meningiomas epidermoid cyst glomus jugulare tumor choroid plexus papilloma metastatic tumors |
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clivial region
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chordoma
meningioma |
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pituitary region
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pituitary adenoma
craniopharyngioma meningioma germ cell tumor sarcoma chordoma metastic tumors |
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corpus callosum
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astrocytoma
glioblastoma lipoma |
