Benign Diseases Flashcards
Non-malignant Diseases
How does vascular endothelial cells respond to radiation?
They respond rapidly by
up-regulating the cytokine-mediated cellular response
Non-malignant Diseases
A total dose of <12 Gy can exert anti-inflammatory effects on endothelial cells of the capillaries.
TRUE or FALSE?
True
Non-malignant Diseases
Risk of Secondary Malignancy
What is the threshold dose below which cancer induction or genetic effects will not occur?
None.
Carcinogenesis or induction of genetic effects is attributed to stochastic effects.
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)
20 mSv
Non-malignant Diseases
Name some genetic syndromes with predisposition to develop meningioma.
NF2
SMARCE1-related meningioma
multiple endocrine neoplasia type 1
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
III
29.2%
Non-malignant Diseases
Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:
Partial macroscopic tumor removal while leaving intradural tumor
parts
IV
39.2%
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
I
8.9%
Non-malignant Diseases
Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:
Simple decompressive and bioptic removal of tumor
V
88.9%
Non-malignant Diseases
Identify the Simpson Grade of Meningioma Removal and the corresponding recurrence rate:
Complete macroscopic tumor removal with adherent dura via
diathermia
II
15.8%
Non-malignant Diseases
What is the CTV for WHO grade I, II, III meningiomas?
0 to 1 cm for WHO grade I
1 to 2 cm for WHO grade II/III
Non-malignant Diseases
What is the usual conventionally fractionated dose prescription range for WHO grade I (benign) meningiomas?
50 to 54 Gy (1.8-2)
Non-malignant Diseases
What is the usual conventionally fractionated dose prescription range for WHO grade II/III meningiomas?
59.4 to 63 (1.8/2)
Non-malignant Diseases
What is the usual dose prescription ranges for WHO meningiomas to be treated stereotactically?
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.
Non-malignant Diseases
Differentiate pico/micro and macroadenomas based on size.
pico <0.3 cm
micro <1 cm
macro >1 cm
Non-malignant Diseases
What medications are often used for the following
- prolactinoma
- GH and TSH adenomas
- ACTH adenomas
- cabergoline and Bromocriptine for prolactinoma
- octreotide for GH and TSH adenomas
- ketoconazole for ACTH adenomas
Non-malignant Diseases
Which of the following can be managed by pharmacotherapy alone?
- prolactinoma
- GH and TSH adenomas
- ACTH adenomas
prolactinoma
Non-malignant Diseases
In functioning pituitary adenomas, what hormones are the quickest and slowest to normalize after RT respectively?
GH and TSH
Non-malignant Diseases
In functioning pituitary adenomas, why should you stop the pharmacotherapy 1-2 months prior to RT?
evidence shows decreased radiosensitivity with concurrent medical treatment.
Non-malignant Diseases
RT dose prescription for pituitary adenomas
conventional fractionation
-functioning
-nonfunctioning
- F 45 to 50.4/1.8-2
- NF 50.4 to 54/1.8-2
Non-malignant Diseases
RT dose prescription for pituitary adenomas
SRS
-functioning
-nonfunctioning
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.
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?
adamantinomatous subtype
Non-malignant Diseases
What is the most common hormone deficiency in craniopharyngioma?
GH
Non-malignant Diseases
What is the dose of the beta-emitters (yttrium 90 and phosphorus 32) for craniopharyngioma?
200 to 250 Gy to the cyst wall
Non-malignant Diseases
What is the typical 3DRT/IMRT dose prescription for craniopharyngioma?
Dose prescriptions for 3DRT and IMRT are typically at least 54 Gy given in 1.8-Gy daily fractions.
Non-malignant Diseases
Bilateral acoustic neuroma is associated with what genetic syndrome?
NF2
Non-malignant Diseases
What is the typical SRS and FSRT dose prescriptions for VS/AN as primary treatment?
SRS: 12-13 Gy
FSRT: 20-25 Gy/5 fractions
Non-malignant Diseases
Salvage RT is equivalent to adjuvant RT in chordomas.
TRUE or FALSE?
False.
Salvage is inferior
Non-malignant Diseases
RT dose for chordoma (EBRT)
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.
Non-malignant Diseases
margins for RT of glomus tumors?
1 to 1.5 cm
Non-malignant Diseases
EBRT dose for glomus tumors?
45 to 55 Gy (1.8 t 2.0)
Non-malignant Diseases
SRS dose for glomus tumors?
15 to 25 Gy LINAC
12.5 to 20 Gy frame-based
Non-malignant Diseases
LC rates are similar using surgery vs. EBRT vs. SRS
for glomus tumors.
TRUE or FALSE?
True
Non-malignant Diseases
What is the most common population of JNA?
adolescent males
Non-malignant Diseases
What are the most common of presentations of JNA?
recurrent epistaxis and impaired nose breathing
Non-malignant Diseases
Where does JNA originates?
first branchial arch atery
Non-malignant Diseases
Chandler Staging for JNA
I
Confined to the nasopharynx
Non-malignant Diseases
Chandler Staging for JNA
II
Extension into nasal cavity and/or sphenoid sinus
Non-malignant Diseases
Chandler Staging for JNA
III
Extension into ≥1 of the following: cheeks, infratemporal fossa, pterygomaxillary fossa,
ethmoid sinus, maxillary antrum
Non-malignant Diseases
Chandler Staging for JNA
IV
Intracranial extension
Non-malignant Diseases
What is the classic electron microscopy finding in Langerhans Histiocytosis X?
Birbeck granules
Non-malignant Diseases
What are the CD expressed by Langerhans Histiocytosis X?
CD1a and CD207
Non-malignant Diseases
RT dose for JNA?
30-50 Gy/2-3Gy
Non-malignant Diseases
Usual dose for untreated and recurrent bony disease in LCH?
6-8 to 15 Gy
Non-malignant Diseases
Scale used to predict hemorrhage risk in AVMs?
Speltzer-Martin scale
Non-malignant Diseases
SRS dose for AVM?
- framebased 50% IDL
- LINAC based
- spinal AVMs
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
Non-malignant Disease
SRS dose for AVM?
- framebased 50% IDL
- LINAC based
- spinal AVMs
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
Non-malignant Diseases
How long after SRS is the usual time it takes to obliteration of the nidus in AVMs?
1 to 4 years
at this time, the patients continue to have bleeding risk, unlike immediate obliteration from surgery
Non-malignant Diseases
How long after SRS is the usual time it takes to obliteration of the nidus in AVMs?
1 to 4 years
at this time, the patients continue to have bleeding risk, unlike immediate obliteration from surgery
Non-malignant Diseases
What is the syndrome associated with platelet trapping within the vascular tumor resulting in consumptive coagulopathy?
Kasabach-Merritt Syndrome
Non-malignant Diseases
What medications are the mainstay of medical management for hemangiomas?
Steroids (gluococrticoids)
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?
10 Gy (1-3 Gy/day)
Non-malignant Diseases
Differentiate Type I from II trigeminal neuralgia
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)
Non-malignant Diseases
Differentiate Type I from II trigeminal neuralgia
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)
Non-malignant Diseases
What are the targets for SRS in trigeminal neuralgia?
- 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
Non-malignant Diseases
What is the prescription dose range for SRS in trigeminal neuralgia?
70 to 90 Gy
Non-malignant Diseases
What is most common sequelae in patients with trigeminal neuralgia treated with SRS?
facial numbness
Non-malignant Diseases
What is the SRS target to relieve Parkinson disease related tremors?
nucleus intermedius (thalamotomy)
Non-malignant Diseases
What is the SRS target to relieve Parkinson disease related rigidity/dyskinesia?
globus pallidus internus (pallidotomy)
Non-malignant Diseases
Which symptoms has achieved mixed results with reported complications compared to success rates of 80% to 90% for the other?
rigidity compared to tremors
Non-malignant Diseases
Which symptoms has achieved mixed results with reported complications compared to success rates of 80% to 90% for the other?
rigidity compared to tremors
Non-malignant Diseases
What is the target in SRS for patients to be treated for OCD?
(anterior limb of) bilateral internal capsule
Non-malignant Diseases
What is the prescription dose in SRS for patients to be treated for OCD?
120 to 140 Gy
140 to 150 by Kondziolka
(180 Gy by Lopes)
Non-malignant Diseases
What is the prescription dose in SRS for patients to be treated for cardiac arrhythmia?
25 Gy
Non-malignant Diseases
What is the RT dose prescription for patients to be treated for sialorrhea?
20 Gy in 4 fractions or 10 Gy in 2 fractions
Non-malignant Diseases
What is the RT dose prescription for patients to be treated for sialorrhea?
20 Gy in 4 fractions or 10 Gy in 2 fractions
Non-malignant Diseases
What syndrome is associated with choroidal hemangiomas?
Sturge-Weber syndrome
Non-malignant Diseases
What is the typical RT dose prescription for circumscribed choroidal hemangioma?
18 to 20 Gy (1.8- to 2)
Non-malignant Diseases
What is the typical RT dose prescription for diffuse choroidal hemangioma?
30 Gy (1.8- to 2)
Non-malignant Diseases
What is the typical isotopes/doses used for the brachytherapy of choroidal hemangioma
60Co, 125I, and Ruthenium 106
25 to 50 Gy
Non-malignant Diseases
What trial supports the use of SRT (16 or 24 Gy) for AMD patients treated with anti-VEGF?
INTREPID
IRay in Conjunction with Anti-VEGF Treatment for Patients with Wet AMD (INTREPID) trial
Non-malignant Diseases
What trial supports the use of SRT (16 or 24 Gy) for AMD patients treated with anti-VEGF?
INTREPID
IRay in Conjunction with Anti-VEGF Treatment for Patients with Wet AMD (INTREPID) trial
Non-malignant Diseases
Graves Ophthalmopathy
What cells lead to an inflammatory reaction secondary to the release of cytokines?
activated T lymphocytes
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?
Smoking
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?
Smoking
Non-malignant Diseases
Graves Ophthalmopathy
What device is used to measure the degree of proptosis on PE?
Hertel exophthalmometer
Non-malignant Diseases
Graves Ophthalmopathy
What are the categories of the SPECS? a measure of the extent of the disease
S-oft tissue involvement P-roptosis E-xtraocular movements (eye muscle dysfunction) C-orneal involvement S-ight loss (visual acuity)
Non-malignant Diseases
Graves Ophthalmopathy
What are the 2 most common EOMs involved?
inferior rectus
medial rectus
Non-malignant Diseases
Graves Ophthalmopathy
What are the 2 most common EOMs involved?
inferior rectus
medial rectus
Non-malignant Diseases
Graves Ophthalmopathy
What is the mainstay of medical management for GO?
Glucocorticoids
Non-malignant Diseases
Graves Ophthalmopathy
How long should GO be inactive before pursuing surgical procedures?
6 months
Non-malignant Diseases
Graves Ophthalmopathy
What are the RT targets?
both orbits, including the entire lengths of the EOMS
Non-malignant Diseases
Graves Ophthalmopathy
When using opposed lateral fields, where do you place the isocenter?
a few millimeters posterior to the lenses using a beam-split technique.
Non-malignant Diseases
Graves Ophthalmopathy
When using opposed lateral fields, where do you place the isocenter?
a few millimeters posterior to the lenses using a beam-split technique.
Non-malignant Diseases
disappearing bone disease/massive osteolysis: other name?
Gorham-Stout syndrome
Non-malignant Diseases
disappearing bone disease/massive osteolysis: other name?
Gorham-Stout syndrome
Non-malignant Diseases
Gorham-Stout dyndrome
RT dose?
36 to 45 Gy
Non-malignant Diseases
synovial disease characterized by sudden onset joint swelling and pain that frequently involves a single joint typically the knee and foot
PVS
Pigmented villonodular synovitis or tenosynovial giant cell tumor
Non-malignant Diseases
Vertebral hemangiomas
RT dose
36 to 40 Gy (2 Gy/fx)
Non-malignant Diseases
Vertebral hemangiomas
RT dose
36 to 40 Gy (2 Gy/fx)
Non-malignant Diseases
Desmoid Tumor
Other names?
aggressive fibromatosis
deep musculoaponeurotic fibromatosis
Non-malignant Diseases
Desmoid Tumor
More common in? (m vs f)
F
Non-malignant Diseases
Desmoid Tumor
Associated genetic mutations?
CTNNB1 gene mutation in the Wnt/B-catenin signaling pathway
APC gene mutation in patients with FAP
Non-malignant Diseases
Desmoid Tumor
most common location aside from extremity?
trunk/intraabdominal
Non-malignant Diseases
Desmoid Tumor
have a high recurrence rate and metastatic potential.
TRUE or FALSE?
false.
high recurrencee rate but low metastatic potential (benign nga eh)
Non-malignant Diseases
Desmoid Tumor
Observation is an option for asymptomatic and stable desmoids.
TRUE or FALSE?
true
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?
True
Non-malignant Diseases
Desmoid Tumor
What is the most widely used NSAID for treatment of desmoid tumors?
Sulindac
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?
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.
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?
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%.
Non-malignant Diseases
Desmoid Tumor
adjuvant radiotherapy for patients with negative margins did
not affect recurrence rates
TRUE or FALSE?
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.
Non-malignant Diseases
Desmoid Tumor
RT dose for adjuvant treatment in patients in whom R0 resection is not possible?
50 to 60 Gy
Non-malignant Diseases
Desmoid Tumor
RT dose for adjuvant treatment in patients in whom R0 resection is not possible?
50 to 60 Gy
Non-malignant Diseases
Other name for Peyronie Disease of the Penis
induratio penis plastica
Non-malignant Diseases
What structure in the penis is most commonly affected PYD, a chronic inflammatory connective tissue disorder
tunica albuginea
Non-malignant Diseases
Which surface of the penis is mostly affected by the plaques in PYD?
dorsal
Non-malignant Diseases
Risk factors for the development of peyronie disease
DM
vascular diseases
Non-malignant Diseases
NonRT/non surgical management of PYD
vitamin E
colchicine
TGF-B1 inhibitors,
coe-Q10
sildenafil
penile injection with verapamil or collagenase
Non-malignant Diseases
RT is more effective in the later stages of Peyronie disease when a visible plaque has fully formed.
TRUE or FALSE?
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
Non-malignant Diseases
RT dose in Peyronie disease
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)
Non-malignant Diseases
RT dose in Peyronie disease
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)
Non-malignant Diseases
Other name for Dupuytren contracure involving the hands
Morbus Dupuytren (MD)
Non-malignant Diseases
Other name for Dupuytren contracure involving the feet
Morbus
Ledderhose (ML)
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
True
Non-malignant Diseases
RT dose for Dupuytren contracture
10 x 3Gy (30 Gy) via split course
or 7 x 3 Gy (21 Gy)
Non-malignant Diseases
What is the target volume in Dupuytren contracture?
detectable and palpable cords + 3 to 5 mm margin
Non-malignant Diseases
What is the target volume in Dupuytren contracture?
detectable and palpable cords + 3 to 5 mm margin
Non-malignant Diseases
Keloids
RT dose?
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
Non-malignant Diseases
Keloids
RT dose?
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
Non-malignant Diseases
Heterotopic Ossification
When do you do prophylactic RT for HO, in relation to surgery?
4 hours prior (preop) or within 72 hours (postop)
Non-malignant Diseases
Heterotopic Ossification
AP-PA cranio caudal borders for RT?
3 cm above the acetabulum encompassing two-thirds of the proximal implant
