Cns Tumors Take Home Donna Spring 2010

Front 1

the majority of adult tumors in the CNS are___

Back 1

gliomas

Front 2

doses commonly used to tx pituitary tumors are___cGy

Back 2

4500-5000 or 5400 cGy for masses larger than 2cm

Front 3

a patient will begin to expeience hair loss ____wks into tx (2000cGy) and hair groth will begin ____months following tx unless the doses above ___cGy was delivered then hair loss is permanent

Back 3

2; 2-3; 4000

Front 4

one of the most radiosensitive cns tumors is______

Back 4

medulloblastomas

Front 5

craniospinal tx includes

Back 5

WB+ boost to brain and spine to S2 or to include the cauda equina

Front 6

tumors of the CNS comprise what % of all cancers occurring in adults and % occuring in children

Back 6

1-2% adults; 20%children

Front 7

eighty percent of CNS tumors involve the

Back 7

brain

Front 8

patients with increased ICP secondary to primary tumors & metastatic brain tumors are txed with each of the following drugs to reduce edema prior to and during RT EXCEPT

a. methotrexate
b. glucocorticoids
c. dexamethasone
d. corticosteroids

Back 8

except methotrexate

Front 9

each of thefollowing are associated with higher CNS occurrence in males EXCEPT

a. white
b astrocytomas
c 50-80years
d meningiomas

Back 9

meningiomas

Front 10

which of the following pituitary tumors are the most common occuring

Back 10

chromophobe and prolactinomas

Front 11

white matter is composed of each of the following EXCEPT

a Oligoendroglia
b Supporting astrocytes
c. Non-dividing neurons
d. nerve fibers and axons

Back 11

except non-dividing neurons

Front 12

the most common tumros occuring in the spinal axis are

Back 12

extradural-metastatic carcinomas

Front 13

each of the following tumors have a propensity for CSF spread EXCEPT

pineoblastoma
ependymoblastoma
low grade astrocytomas
medulloblastoma

Back 13

low grade astrocytomas

Front 14

twenty to forty percent of brain tumros are metastatic tumors from commonly each of the following areas

1.melanoma
2Gi
3.lung
4.prostate
5breast
6Kidney
7.Hodgkin's Disease

Back 14

1,2,3,4,5,6 NOT 7

Front 15

RT's total standard dose schedules of ____are commonly used for primary tumors of the brain

Back 15

5000-6000cGy given in 180-200cGy fx or 6400cGy in 1.8fx

Front 16

majority of adult cns tumors are

Back 16

supratentorial tumors

Front 17

____predominately arise in white mater, tend to present a single mass arising in one hemispere, in adults commonly arise in cerebrum and represent the most common glioma

Back 17

astrocytoma (including glioblastoma multiform)

Front 18

diagnostic work-up exam to look for papilledema as a sign for increased intracranial pressure is __

Back 18

funduscopic exam using a ophthalmoscope

Front 19

which of the following statements are correct regarding tumors of the CNS in children

1. usually supratentorial locations
2. second disease related cause to death in children
3. most commonly tumors are located in the medulla, cerebellum, midbrain, and pons
4. 20% of the tumors occur in infants and children under 3yrs and tend more to be malignant
5. CNS in children reaches morphologic maturations by 2yr

Back 19

2,3,4,5, and 6

Front 20

complete resection with RT for residual or recurrent tumor and no role for chemo is the common tx for

Back 20

meningioma and low grade glioma

Front 21

____is the imaging choice when fo the detetion of meningeal involvement and for tumors near the skull, posterior fossa and as a screening procedure for diagnosing and localizing tumors in the brain stem, posterior fossa, spinal cord and defining the extent of low grade gliomas

Back 21

MRI

Front 22

the primary route of spread for CNS tumors is

Back 22

local along the subarachnoid and ventricular space and in the spinal cord

Front 23

"early delayed" symptoms of somnolence and fatigue are often observed___ months following cranial RT and possibly related to ____

Back 23

6-12; transient demyelination

Front 24

______is a work-up procedure used to differentiate active tumor from necrosis or low grade gliomas from nontumoral lesions, based on evaluating metabolic patterns

Back 24

PET SPECT or MRI SPECT

Front 25

each of the following are correct regarding teh administration of radiosurgery or stereotactic radiation for brain lesions EXCEPT

a. critical structures are optic nerve adn brain stem
b. dose is delivered through linear accelerators providing high energy gamma rays or through gamma knife providing high energy photons
c high dose volume is administered to a small volume sparing normal structures
d target usually do not exceed 3-4cm

Back 25

except B
"dose is delivered through linear accelerators providing high energy gamma rays or through gamma knife providing high energy photons"

Front 26

analysis of CSF can be useful work-up for CNS tumors for levels of:

1. CNS glucose is usually low in the presence of highly malignant tumors or metastatic meningeal deposits
2. CSF exams is helpful for staging primary CNS lymphoma, medulloblastoma, pineoblastoma, and PET to determine microscopic seeding to cranial spinal axis
3. CSF protein levels are lower in patients with spinal cord tumors
4. lumber puncture should be avoided in patients with obvious evidence of increased intracranial pressure since there would be a risk of herniation with the procedure
5 CSF protein is elevated in 1/3 of patiens in the presence of intracranial tumor

Back 26

1,2,4,and 5

Front 27

primary intracranial tumors derived from the vessels, meninges, and blood components are classified as tumors arising from ___germinal origin

Back 27

mesoderm

Front 28

each of the following prognostic features would be linked with higher survival EXCEPT

a. karnofsky performance status of 80-100
b tumor markers with tumor cells actively replicating with a labeling index of less than 5%
c tumors size-smaller than 3-5cm
d. age-greater than 65years

Back 28

except
d. age-greater than 65years

Front 29

children less than____ years should be given chemo for followed closely following surgical resection until either the tumor has progressed to where RT is required

Back 29

4

Front 30

which of the following statements are CORRECT regarding pituitary tumors

1. most commonly occurs as malignant
2. symptoms-most common cause of pituitary dysfunction in adults, visual impairment or cranial involvement
3. chromophobe adenomas are known as the endocrine active tumors
4. pituitary gland is a midline structure located in the sella turcica in the body of the sphenoid bone
5. structures bordering the pituitary gland-anterior and superior is optic chiasm, canvernous sinus is lateral, and sphenoid sinus below
6. RT can control 80% of hyperscretion of increased growth gormones, 50-80% of increased ACTH and 33% of increased prolactin
7 Radiographically the sella is located 1/3 inch anterior to and 1/4 inch above the acoustic meatuses
8 tx fields are usually right and left lateral and a vertex field or arcing
9 fields are usually 5x5 or 6x6 cm, 2lateral and a vertex field or arcing fields or bilateral coaxial fields; target volume enclosed in 95% isodose line

Back 30

2,4,5,6, and 9

Front 31

the most serious late radiation reation which ccurs several months to years after tx to teh brain and is irreversible and progressive with increasing occurance with doses above 7000cGy (TD50/5) is

Back 31

brain necrosis

Front 32

WB radiation fields are usually reserved for each of the following EXCEPT

low grade single astrocytoma
ependymal involved lesions
brain metastastsis
multifocal lesions

Back 32

except low grade single astrocytoma

Front 33

Each of the following are accurate anatomical landmarks aften used in setting up CNS tumors EXCEPT

(too long to write so ....just remember the one incorrect)

Back 33

C is incorrect
external acoustic meatus- asymmetric and help define the reference planes in the hand (Reid's baseline and Frankfort horisontal plane, connecting points in the two external acoustic meatus and one anterior infraorbital edge) should be marked at simulation since they may be difficult to see because o the overlying parietal lobe

Front 34

tx dose schedules delivering greater than___Gy per fx are to brain fields are associated with higher risk of late CNS toicity

Back 34

2Gy

Front 35

limited fields for primary brain tumors is usually treated with a ___cm contrast enhanced margin through two___fields arrangements

Back 35

2-3; wedged

Front 36

brain tumors txed with arc rotation with reversed edges would result in a ____dose distribution

Back 36

elliptoid

Front 37

which of the following statements are correct when considering tx of spinal tumors

(too long to write out)

Back 37

1,2,3,4,5, and 6 are correct so all of them

Front 38

doses of _____Gy to the hypothalamic pituitary axis may be associated with hormone insufficiency

Back 38

20

Front 39

the role of chemo for CNS tumors is correct in each of the following statements EXCEPT

a. used in conjunction with surgery and RT
b. common chem. agents used lipid soluble-Nitrosoureas, vincristine, AZQ, cisplatin and procarbazine
c tumors with leptoeningeal spread or at high risk of CSF spread need direct intrathecal injections using theotepa, methotrexate, or cystosine arabinoside
d. tumors often txed with chemo agents include low grade asrocytomas, oligodendroglioa, and eningioma

Back 39

D is incorrect "tumors often txed with chemo agents include low grade asrocytomas, oligodendroglioa, and eningioma"

Front 40

Which of the following statements are correct regarding to the tx of neuraxis or craniospinal fields

(too long to write it takes up 1/2 the page)

Back 40

1.2.3.4.5.6.7.8 and 9
so all correct