Lung Cancer Short Answer Test Spring 2010

Front 1

Identify epidemiologic factors:

Back 1

Lung cancer is 1st in death rate (160,000 deaths in 2009) and 2nd in incidence (220,000 new cases in 2009). Male has decreased while women has plateau.

Front 2

List the etiologic factors that could induce this tumor:

Back 2

cigarette smoking, occupational or environmental exposure to secondhand smoke, radon, asbestos, certain metals, some organic chemicals, radiation, air pollution and a history of tuberculosis or genetic family history.

Front 3

Identify the differing pathologic types associated with this tumor:

Back 3

-Small Cell Carcinoma – most commonly occurring

-Non-Small Cell Carcinoma

-Adenocarcinoma – second most commonly occurring – non smokers

-Squamous Cell Carcinoma – smokers – higher survival rate

Front 4

Describe the clinical manifestations:

Back 4

Cough, hemoptysis, dyspnea, weight loss, weakness, anorexia, and depression

Front 5

List the common diagnostic procedures used to work-up and stage the patient:

Back 5

Chest x-ray, CT, PET and MRI

Front 6

Treatment techniques and Dose schedules:

Back 6

AP/PA to 45Gy followed by oblique portals to boost the tumor and avoid exceeding tolerance to lung, spinal cord and heart. Total doses of 65-70Gy are used.

Front 7

Patient position and immobilization devices:

Back 7

Supine with arms above head, upper vacloc and large sponge under knees.

Front 8

Treatment for upper lobe tumor or Middle lobe with mediastinal nodes:

Back 8

primary tumor, both hilar areas, superior mediastinum, and both supraclavicular areas.

Front 9

Middle lobes without mediastinal nodes:

Back 9

primary tumor, both hilar areas and superior mediastinum

Front 10

Lower lobes without mediastinal nodes:

Back 10

primary tumor and entire mediastinum.

Front 11

Lower lobes with mediastinal adenopathy:

Back 11

primary tumor, entire mediastinum and both supraclavicular areas.

Front 12

Superior Sulcus Lung Carcinoma:

Back 12

ipsilateral supraclavicular node, adjacent vertebral body, upper lobe, upper mediastinal nodes, and ipsilateral hilar nodes and subcarinal nodes.

Front 13

Superior Vena Cava Syndrome:

Back 13

mediastinal, hilar, and any adjacent pulmonary parenchymal lesions and supraclavicular nodes

Front 14

cm Margin:

Back 14

2cm margin around GTV and 1cm around lymphatics

Front 15

Acute and Chronic complications:

Back 15

Acute – Radiation esophagitis: 30Gy – mucosal anesthetics

Chronic – Pneumonitis: 20-22 Gy, Spinal cord myelopathy: 45Gy.

Front 16

Education:

Back 16

Therapist must educate patients during testing procedures and their daily treatments to include any doctor visits and blood work. Information to include: the reasons that the tests are needed, the location and time to report, and special requirements such as fasting. Patient education is important from the time of consultation to the last day of treatment. Therapist can ensure patient understanding by asking questions.

Front 17

Communication:

Back 17

Details related to daily treatments, appointment times, and the length of treatment require initial education followed by frequent reinforcement. Communication must be continuous throughout the course of treatment.

Front 18

assessment

Back 18

Assessment is the process of evaluating a patient’s condition. Patient’s skin should be assessed daily before treatment including dermatitis and erythema. Skin care should be given to patient to prevent skin breakdown. If skin breakdown occurs, treatment should be withheld until a physicians medical opinion is obtained.

A nutritional evaluation of the ability to swallow solid foods, liquids, and medication should be done to determine whether dietary counseling or medical intervention is required. Patient must stay hydrated.

White blood cell counts of 2000 or less and platelets of 50,000 or less should not be treated without a written order. Chemo patients must be monitored closely.

Metastasis of lung to CNS or skeletal system. Brain mets - watch for personality changes, headaches and visual disturbances. Spine mets – severe neck or back pain and they may describe bowel and /or bladder dysfunctions such as incontinence. Pleural or pericardial effusions include dyspnea, increased respiratory effort, chest pain, a change in a cough, or a fever.

Front 19

Thyroid-

Role of RT:

Back 19

Thyroid-

Role of RT: Responsiveness to external beam radiation varies according to histologic type and can be used alone or in combination with I-131 and surgery.

Front 20

Tyroid
patient position

Back 20

Patient position: Supine with head extended to avoid exposure to the mouth, with the use of immobilization device for reproductivity.

Front 21

Thyroid
beam entries and doses

Back 21

Beam entries and doses: AP/PA portal with 4500cGy given at the midplane to the neck and mediastinum (cord blocked at 4500cGy). Additional dose to 6500cGy delivered through anterior obliques or opposed oblique portals.

Front 22

Adrenal-

Role of RT:

Back 22

Adrenal-

Role of RT: RT can be used in addition to surgery to improve local control and reduce pain for palliative treatment.

Front 23

Adrenal
beam entries and doses

Back 23

Beam entries and doses: AP/PA portal and parallel opposed wedged lateral fields to a total of 50-60Gy and blocking the cord at 45Gy.

Front 24

adrenal
patient positioning

Back 24

supine upper and lower vac loc, arms up legs slightly spread

Front 25

Definitive irradiation
dose
role

Back 25

Definitive irradiation
dose:50-79.2 Gy in 1.8-2.0Gy fractions
role:Cure of Non-small cell carcinoma.

Front 26

Intraoperative
dose
role

Back 26

intraoperative

dose 10-15Gy boost doses
role Increases the total dose delivered to the tumor without exposing normal surrounding structures.

Front 27

Split course schedule
dose
role

Back 27

Split course schedule
dose :25-30Gy in 2-3 weeks, 2-4 week rest between two split courses.
role: Gives the body time to heal.

Front 28

Hyperfractionation
dose
role

Back 28

Hyperfractionation
Dose:
Multiple daily fractions of 1.2-1.5Gy to a total dose of 79.2Gy
Role:
Higher doses of radiation to tumor without increasing morbidity in normal tissues.

Front 29

hypofractionation
dose
role

Back 29

Hypofractionation
dose 5Gy weekly for 10-12 fractions
role Local palliation with reduced acute side effects. Also for pts with advanced lung cancer who are in poor general conditions.

Front 30

preoperative
dose
role

Back 30

Preoperative irradiation
no dose
role: No longer used except for patients with superior sulcus (Pancoast’s) tumor.

Front 31

post operative radiation
dose
role

Back 31

Post operative radiation
dose: 50-60Gy in 5 weeks
role: Has no role after complete resection of T1-T2, N0, or M0 NSCLC tumors.

Front 32

Chemoradiotherapy
dose
role

Back 32

Chemoradiotherapy
NSCLC: Cisplatin-based chemo before 60-65Gy.
SCLC: Cisplatin with 45Gy
Improve survival for distant metastases.

Front 33

HDR
dose
role

Back 33

HDR
5Gy in 3 fractions or one 10Gy fraction
For relief of bronchial obstruction.