Benign Diseases Flashcards by Mario Luna | Brainscape

Q

Non-malignant Diseases

How does vascular endothelial cells respond to radiation?

A

They respond rapidly by

up-regulating the cytokine-mediated cellular response

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Q

Non-malignant Diseases

A total dose of <12 Gy can exert anti-inflammatory effects on endothelial cells of the capillaries.

TRUE or FALSE?

A

True

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Q

Non-malignant Diseases

Risk of Secondary Malignancy

What is the threshold dose below which cancer induction or genetic effects will not occur?

A

None.

Carcinogenesis or induction of genetic effects is attributed to stochastic effects.

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Q

Non-malignant Diseases

Risk of Secondary Malignancy

What is the typical limit for radiation workers per year which in general population increases the lifetime cancer risk by about 0.1% (5.5%/Sv)

A

20 mSv

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Q

Non-malignant Diseases

Name some genetic syndromes with predisposition to develop meningioma.

A

NF2

SMARCE1-related meningioma

multiple endocrine neoplasia type 1

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Q

Non-malignant Diseases

Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:

Complete macroscopic tumor removal without adherent dura or
possibly additional extradural parts

A

III

29.2%

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Q

Non-malignant Diseases

Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:

Partial macroscopic tumor removal while leaving intradural tumor
parts

A

IV

39.2%

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Q

Non-malignant Diseases

Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:

Complete macroscopic tumor removal with adherent dura as well as
the possibly affected part of the cranial calotte

A

I

8.9%

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Q

Non-malignant Diseases

Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:

Simple decompressive and bioptic removal of tumor

A

V

88.9%

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Q

Non-malignant Diseases

Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:

Complete macroscopic tumor removal with adherent dura via
diathermia

A

II

15.8%

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Q

Non-malignant Diseases

What is the CTV for WHO grade I, II, III meningiomas?

A

0 to 1 cm for WHO grade I

1 to 2 cm for WHO grade II/III

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Q

Non-malignant Diseases

What is the usual conventionally fractionated dose prescription range for WHO grade I (benign) meningiomas?

A

50 to 54 Gy (1.8-2)

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Q

Non-malignant Diseases

What is the usual conventionally fractionated dose prescription range for WHO grade II/III meningiomas?

A

59.4 to 63 (1.8/2)

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Q

Non-malignant Diseases

What is the usual dose prescription ranges for WHO meningiomas to be treated stereotactically?

A

Typical dose prescriptions for frame-based SRS range from

12 to 16 Gy prescribed to the 50% isodose line (IDL) and 14 to 18 Gy prescribed to the 80% IDL for a frameless robotic radiosurgery platform.

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Q

Non-malignant Diseases

Differentiate pico/micro and macroadenomas based on size.

A

pico <0.3 cm
micro <1 cm
macro >1 cm

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Q

Non-malignant Diseases

What medications are often used for the following

prolactinoma
GH and TSH adenomas
ACTH adenomas

A

cabergoline and Bromocriptine for prolactinoma
octreotide for GH and TSH adenomas
ketoconazole for ACTH adenomas

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Q

Non-malignant Diseases

Which of the following can be managed by pharmacotherapy alone?

prolactinoma
GH and TSH adenomas
ACTH adenomas

A

prolactinoma

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Q

Non-malignant Diseases

In functioning pituitary adenomas, what hormones are the quickest and slowest to normalize after RT respectively?

A

GH and TSH

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Q

Non-malignant Diseases

In functioning pituitary adenomas, why should you stop the pharmacotherapy 1-2 months prior to RT?

A

evidence shows decreased radiosensitivity with concurrent medical treatment.

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Q

Non-malignant Diseases

RT dose prescription for pituitary adenomas
conventional fractionation
-functioning
-nonfunctioning

A

F 45 to 50.4/1.8-2

- NF 50.4 to 54/1.8-2

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Q

Non-malignant Diseases

RT dose prescription for pituitary adenomas
SRS
-functioning
-nonfunctioning

A

Commonly used prescriptions are 16 to 20 Gy in a single fraction for nonfunctioning adenomas and 20 to 25 Gy in a single fraction for functional adenomas using a frameless robotic RS platform.

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Q

Non-malignant Diseases

What subtype of craniopharyngioma is characterized by a solid and cystic pattern with the well-known description of “machine oil–like” cystic fluid?

A

adamantinomatous subtype

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Q

Non-malignant Diseases

What is the most common hormone deficiency in craniopharyngioma?

A

GH

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Q

Non-malignant Diseases

What is the dose of the beta-emitters (yttrium 90 and phosphorus 32) for craniopharyngioma?

A

200 to 250 Gy to the cyst wall

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Q

Non-malignant Diseases

What is the typical 3DRT/IMRT dose prescription for craniopharyngioma?

A

Dose prescriptions for 3DRT and IMRT are typically at least 54 Gy given in 1.8-Gy daily fractions.

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Q

Non-malignant Diseases

Bilateral acoustic neuroma is associated with what genetic syndrome?

A

NF2

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Q

Non-malignant Diseases

What is the typical SRS and FSRT dose prescriptions for VS/AN as primary treatment?

A

SRS: 12-13 Gy
FSRT: 20-25 Gy/5 fractions

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Q

Non-malignant Diseases

Salvage RT is equivalent to adjuvant RT in chordomas.

TRUE or FALSE?

A

False.

Salvage is inferior

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Q

Non-malignant Diseases

RT dose for chordoma (EBRT)

A

Dose prescriptions to the PTV for patients receiving photon-based treatment should be at least 60 Gy given in 1.8 to 2.0-Gy daily fractions.

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Q

Non-malignant Diseases

margins for RT of glomus tumors?

A

1 to 1.5 cm

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Q

Non-malignant Diseases

EBRT dose for glomus tumors?

A

45 to 55 Gy (1.8 t 2.0)

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Q

Non-malignant Diseases

SRS dose for glomus tumors?

A

15 to 25 Gy LINAC

12.5 to 20 Gy frame-based

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Q

Non-malignant Diseases

LC rates are similar using surgery vs. EBRT vs. SRS
for glomus tumors.

TRUE or FALSE?

A

True

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Q

Non-malignant Diseases

What is the most common population of JNA?

A

adolescent males

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Q

Non-malignant Diseases

What are the most common of presentations of JNA?

A

recurrent epistaxis and impaired nose breathing

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Q

Non-malignant Diseases

Where does JNA originates?

A

first branchial arch atery

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Q

Non-malignant Diseases
Chandler Staging for JNA

I

A

Confined to the nasopharynx

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Q

Non-malignant Diseases
Chandler Staging for JNA

II

A

Extension into nasal cavity and/or sphenoid sinus

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Q

Non-malignant Diseases
Chandler Staging for JNA

III

A

Extension into ≥1 of the following: cheeks, infratemporal fossa, pterygomaxillary fossa,
ethmoid sinus, maxillary antrum

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Q

Non-malignant Diseases
Chandler Staging for JNA

IV

A

Intracranial extension

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Q

Non-malignant Diseases

What is the classic electron microscopy finding in Langerhans Histiocytosis X?

A

Birbeck granules

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Q

Non-malignant Diseases

What are the CD expressed by Langerhans Histiocytosis X?

A

CD1a and CD207

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Q

Non-malignant Diseases

RT dose for JNA?

A

30-50 Gy/2-3Gy

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Q

Non-malignant Diseases

Usual dose for untreated and recurrent bony disease in LCH?

A

6-8 to 15 Gy

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Q

Non-malignant Diseases

Scale used to predict hemorrhage risk in AVMs?

A

Speltzer-Martin scale

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Q

Non-malignant Diseases

SRS dose for AVM?

framebased 50% IDL
LINAC based
spinal AVMs

A

21 to 22 Gy prescribed to the 50% IDL for frame-based
radiosurgery

LINAC-based SRS, 16 to 24 Gy in a single fraction to 20 to 22 Gy in 2
fractions for spinal AVMs

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Q

Non-malignant Disease

SRS dose for AVM?

framebased 50% IDL
LINAC based
spinal AVMs

A

21 to 22 Gy prescribed to the 50% IDL for frame-based
radiosurgery

LINAC-based SRS, 16 to 24 Gy in a single fraction to 20 to 22 Gy in 2
fractions for spinal AVMs

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Q

Non-malignant Diseases

How long after SRS is the usual time it takes to obliteration of the nidus in AVMs?

A

1 to 4 years

at this time, the patients continue to have bleeding risk, unlike immediate obliteration from surgery

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Q

Non-malignant Diseases

How long after SRS is the usual time it takes to obliteration of the nidus in AVMs?

A

1 to 4 years

at this time, the patients continue to have bleeding risk, unlike immediate obliteration from surgery

Q

Non-malignant Diseases

What is the syndrome associated with platelet trapping within the vascular tumor resulting in consumptive coagulopathy?

A

Kasabach-Merritt Syndrome

Q

Non-malignant Diseases

What medications are the mainstay of medical management for hemangiomas?

A

Steroids (gluococrticoids)

Q

Non-malignant Diseases

Radiotherapy is indicated only in patients that have exhausted all other treatment
options. When RT is used, responses are often quick and dramatic.

What is the usual dose prescription?

A

10 Gy (1-3 Gy/day)

Q

Non-malignant Diseases

Differentiate Type I from II trigeminal neuralgia

A

I - sudden shocks of sharp, lancinating facial pain seconds to minutes with pain-free intervals, good pain pain free with lasting control.

II - constant burning, aching, throbbing pain, generally of lower intensity.

(typically, they are type1-idiopathic, type2-secondary)

Q

Non-malignant Diseases

Differentiate Type I from II trigeminal neuralgia

A

I - sudden shocks of sharp, lancinating facial pain seconds to minutes with pain-free intervals, good pain pain free with lasting control.

II - constant burning, aching, throbbing pain, generally of lower intensity.

(typically, they are type1-idiopathic, type2-secondary)

Q

Non-malignant Diseases

What are the targets for SRS in trigeminal neuralgia?

A

the anatomical emergence of the TN from the pons (proximal dorsal root entry zone or DREZ, prepontine cistern slightly anterior of the pons
the retrogasserian target
semilunar ganglion

Q

Non-malignant Diseases

What is the prescription dose range for SRS in trigeminal neuralgia?

A

70 to 90 Gy

Q

Non-malignant Diseases

What is most common sequelae in patients with trigeminal neuralgia treated with SRS?

A

facial numbness

Q

Non-malignant Diseases

What is the SRS target to relieve Parkinson disease related tremors?

A

nucleus intermedius (thalamotomy)

Q

Non-malignant Diseases

What is the SRS target to relieve Parkinson disease related rigidity/dyskinesia?

A

globus pallidus internus (pallidotomy)

Q

Non-malignant Diseases

Which symptoms has achieved mixed results with reported complications compared to success rates of 80% to 90% for the other?

A

rigidity compared to tremors

Q

Non-malignant Diseases

Which symptoms has achieved mixed results with reported complications compared to success rates of 80% to 90% for the other?

A

rigidity compared to tremors

Q

Non-malignant Diseases

What is the target in SRS for patients to be treated for OCD?

A

(anterior limb of) bilateral internal capsule

Q

Non-malignant Diseases

What is the prescription dose in SRS for patients to be treated for OCD?

A

120 to 140 Gy

140 to 150 by Kondziolka
(180 Gy by Lopes)

Q

Non-malignant Diseases

What is the prescription dose in SRS for patients to be treated for cardiac arrhythmia?

A

25 Gy

Q

Non-malignant Diseases

What is the RT dose prescription for patients to be treated for sialorrhea?

A

20 Gy in 4 fractions or 10 Gy in 2 fractions

Q

Non-malignant Diseases

What is the RT dose prescription for patients to be treated for sialorrhea?

A

20 Gy in 4 fractions or 10 Gy in 2 fractions

Q

Non-malignant Diseases

What syndrome is associated with choroidal hemangiomas?

A

Sturge-Weber syndrome

Q

Non-malignant Diseases

What is the typical RT dose prescription for circumscribed choroidal hemangioma?

A

18 to 20 Gy (1.8- to 2)

Q

Non-malignant Diseases

What is the typical RT dose prescription for diffuse choroidal hemangioma?

A

30 Gy (1.8- to 2)

Q

Non-malignant Diseases

What is the typical isotopes/doses used for the brachytherapy of choroidal hemangioma

A

60Co, 125I, and Ruthenium 106

25 to 50 Gy

Q

Non-malignant Diseases

What trial supports the use of SRT (16 or 24 Gy) for AMD patients treated with anti-VEGF?

A

INTREPID

IRay in Conjunction with Anti-VEGF Treatment for Patients with
Wet AMD (INTREPID) trial

Q

Non-malignant Diseases

What trial supports the use of SRT (16 or 24 Gy) for AMD patients treated with anti-VEGF?

A

INTREPID

IRay in Conjunction with Anti-VEGF Treatment for Patients with
Wet AMD (INTREPID) trial

Q

Non-malignant Diseases
Graves Ophthalmopathy

What cells lead to an inflammatory reaction secondary to the release of cytokines?

A

activated T lymphocytes

Q

Non-malignant Diseases
Graves Ophthalmopathy

What is the greatest risk factor for the development of GO and also a predictor for poorer response to therapy?

A

Smoking

Q

Non-malignant Diseases
Graves Ophthalmopathy

What is the greatest risk factor for the development of GO and also a predictor for poorer response to therapy?

A

Smoking

Q

Non-malignant Diseases
Graves Ophthalmopathy

What device is used to measure the degree of proptosis on PE?

A

Hertel exophthalmometer

Q

Non-malignant Diseases
Graves Ophthalmopathy

What are the categories of the SPECS? a measure of the extent of the disease

A

S-oft tissue involvement
P-roptosis
E-xtraocular movements (eye muscle dysfunction)
C-orneal involvement
S-ight loss (visual acuity)

Q

Non-malignant Diseases
Graves Ophthalmopathy

What are the 2 most common EOMs involved?

A

inferior rectus

medial rectus

Q

Non-malignant Diseases
Graves Ophthalmopathy

What are the 2 most common EOMs involved?

A

inferior rectus

medial rectus

Q

Non-malignant Diseases
Graves Ophthalmopathy

What is the mainstay of medical management for GO?

A

Glucocorticoids

Q

Non-malignant Diseases
Graves Ophthalmopathy

How long should GO be inactive before pursuing surgical procedures?

A

6 months

Q

Non-malignant Diseases
Graves Ophthalmopathy

What are the RT targets?

A

both orbits, including the entire lengths of the EOMS

Q

Non-malignant Diseases
Graves Ophthalmopathy

When using opposed lateral fields, where do you place the isocenter?

A

a few millimeters posterior to the lenses using a beam-split technique.

Q

Non-malignant Diseases
Graves Ophthalmopathy

When using opposed lateral fields, where do you place the isocenter?

A

a few millimeters posterior to the lenses using a beam-split technique.

Q

Non-malignant Diseases

disappearing bone disease/massive osteolysis: other name?

A

Gorham-Stout syndrome

Q

Non-malignant Diseases

disappearing bone disease/massive osteolysis: other name?

A

Gorham-Stout syndrome

Q

Non-malignant Diseases
Gorham-Stout dyndrome

RT dose?

A

36 to 45 Gy

Q

Non-malignant Diseases

synovial disease characterized by sudden onset joint swelling and pain that frequently involves a single joint typically the knee and foot

A

PVS

Pigmented villonodular synovitis or tenosynovial giant cell tumor

Q

Non-malignant Diseases
Vertebral hemangiomas

RT dose

A

36 to 40 Gy (2 Gy/fx)

Q

Non-malignant Diseases
Vertebral hemangiomas

RT dose

A

36 to 40 Gy (2 Gy/fx)

Q

Non-malignant Diseases
Desmoid Tumor

Other names?

A

aggressive fibromatosis

deep musculoaponeurotic fibromatosis

Q

Non-malignant Diseases
Desmoid Tumor

More common in? (m vs f)

A

F

Q

Non-malignant Diseases
Desmoid Tumor

Associated genetic mutations?

A

CTNNB1 gene mutation in the Wnt/B-catenin signaling pathway

APC gene mutation in patients with FAP

Q

Non-malignant Diseases
Desmoid Tumor

most common location aside from extremity?

A

trunk/intraabdominal

Q

Non-malignant Diseases
Desmoid Tumor

have a high recurrence rate and metastatic potential.

TRUE or FALSE?

A

false.

high recurrencee rate but low metastatic potential (benign nga eh)

Q

Non-malignant Diseases
Desmoid Tumor

Observation is an option for asymptomatic and stable desmoids.

TRUE or FALSE?

A

true

Q

Non-malignant Diseases
Desmoid Tumor

Complete surgical resection of the tumor with negative
microscopic margins is the treatment of choice for most desmoid tumors.

Desmoid tumors have a high rate of recurrence following even
complete surgical removal.

TRUE or FALSE?

A

True

Q

Non-malignant Diseases
Desmoid Tumor

What is the most widely used NSAID for treatment of desmoid tumors?

A

Sulindac

Q

Non-malignant Diseases
Desmoid Tumor

What hormonal treatment can be given to desmoid tumor patients with a similar regimen as those used in breast cancer?

A

tamoxifen 10mg daily

Tamoxifen has been used most
widely and is typically prescribed at doses similar to those used for breast cancer
(10 mg daily). Much higher doses (120 mg daily) have been recommended,
but high-dose tamoxifen is difficult to tolerate, and there is no evidence to
suggest that higher doses of tamoxifen are better than lower doses.

Q

Non-malignant Diseases
Desmoid Tumor

Desmoid tumors respond to TK inhibitors due to desmoid’s expression of the PDGF receptor.
What is the most commonly used agent?

A

Imatinib (Gleevec) 800 mg/daly

Kasper et al. prospectively administered imatinib (800
mg/daily) to patients with desmoid tumors not amenable to R0 resection without
significant function loss and demonstrated a 2-year progression arrest rate of
45%.

Q

Non-malignant Diseases
Desmoid Tumor

adjuvant radiotherapy for patients with negative margins did
not affect recurrence rates

TRUE or FALSE?

A

true.

Janssen et al.
performed a meta-analysis on the influence of surgical margin and adjuvant RT
on local recurrence and found that RT reduces the risk of recurrence in patients
with microscopically positive resection margins. The association of adjuvant RT
benefit was even stronger for resection of recurrent tumors with positive
margins. Of note, adjuvant radiotherapy for patients with negative margins did
not affect recurrence rates.

Q

Non-malignant Diseases
Desmoid Tumor

RT dose for adjuvant treatment in patients in whom R0 resection is not possible?

A

50 to 60 Gy

Q

Non-malignant Diseases
Desmoid Tumor

RT dose for adjuvant treatment in patients in whom R0 resection is not possible?

A

50 to 60 Gy

Q

Non-malignant Diseases

Other name for Peyronie Disease of the Penis

A

induratio penis plastica

Q

Non-malignant Diseases

What structure in the penis is most commonly affected PYD, a chronic inflammatory connective tissue disorder

A

tunica albuginea

Q

Non-malignant Diseases

Which surface of the penis is mostly affected by the plaques in PYD?

A

dorsal

Q

Non-malignant Diseases

Risk factors for the development of peyronie disease

A

DM

vascular diseases

Q

Non-malignant Diseases

NonRT/non surgical management of PYD

A

vitamin E
colchicine

TGF-B1 inhibitors,
coe-Q10
sildenafil

penile injection with verapamil or collagenase

Q

Non-malignant Diseases

RT is more effective in the later stages of Peyronie disease when a visible plaque has fully formed.

TRUE or FALSE?

A

False

any benefit of RT is best in the
treatment of early stages of disease, when radioresponsive inflammatory cells
and fibroblasts are still active in the disease. RT in later stages of PYD once the
plaques have fully formed is thought to yield worse outcomes

Q

Non-malignant Diseases

RT dose in Peyronie disease

A

10 to 20 Gy (2-3 Gy daily)

low dose:
13.5 (9 x 1.5 Gy, 3x/week)
12 (6 x 2 Gy daily)

Q

Non-malignant Diseases

RT dose in Peyronie disease

A

10 to 20 Gy (2-3 Gy daily)

low dose:
13.5 (9 x 1.5 Gy, 3x/week)
12 (6 x 2 Gy daily)

Q

Non-malignant Diseases

Other name for Dupuytren contracure involving the hands

A

Morbus Dupuytren (MD)

Q

Non-malignant Diseases

Other name for Dupuytren contracure involving the feet

A

Morbus

Ledderhose (ML)

Q

Non-malignant Diseases

Radiotherapy is currently used in the treatment of Dupuytren’s exclusively for
early-stage patients (who have a <10-degree deformity) and is considered
standard of care for prevention of Dupuytren progression.

TRUE or FALSE

A

True

Q

Non-malignant Diseases

RT dose for Dupuytren contracture

A

10 x 3Gy (30 Gy) via split course

or 7 x 3 Gy (21 Gy)

Q

Non-malignant Diseases

What is the target volume in Dupuytren contracture?

A

detectable and palpable cords + 3 to 5 mm margin

Q

Non-malignant Diseases

What is the target volume in Dupuytren contracture?

A

detectable and palpable cords + 3 to 5 mm margin

Q

Non-malignant Diseases
Keloids

RT dose?

A

Achieving a BED of 15 to 22.5 Gy (at
α/β of 10) with 10, 12, or 20 Gy delivered within 1 week over 2, 3, or 4
fractions, respectively, is sufficient for efficacy evaluated by relapse rate and
good cosmesis

Q

Non-malignant Diseases
Keloids

RT dose?

A

Achieving a BED of 15 to 22.5 Gy (at
α/β of 10) with 10, 12, or 20 Gy delivered within 1 week over 2, 3, or 4
fractions, respectively, is sufficient for efficacy evaluated by relapse rate and
good cosmesis

Q

Non-malignant Diseases
Heterotopic Ossification

When do you do prophylactic RT for HO, in relation to surgery?

A

4 hours prior (preop) or within 72 hours (postop)

Q

Non-malignant Diseases
Heterotopic Ossification

AP-PA cranio caudal borders for RT?

A

3 cm above the acetabulum encompassing two-thirds of the proximal implant