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Radiation Therapy > Bone Tumors and Soft Tissue Sarcomas Procedures Powerpoint > Flashcards

Bone Tumors and Soft Tissue Sarcomas Procedures Powerpoint Flashcards

1
Q

Where types of soft tissue tumors occur?

A

Fat

Muscle

Nerve

Fibrous

Deep Skin

Blood vessel

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2
Q

How are primary bone tumors classified?

A

According to normal cell of origin

apparent pattern of differentiation

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3
Q

What are the 3 categories of primary bone forming tumors?

A

osteoma

osteoid osteoma and osteoblastoma

osteosarcoma

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4
Q

What are the 3 cartilage forming tumors?

A

Chondroma (interchangeable with enchondroma)

osteochondroma

chondrosarcoma

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5
Q

What are the miscellaneous primary bone tumors?

A

Ewing’s sarcoma

Giant cell tumor of bone

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6
Q

What tumors are found in the epiphysis?

A

chonroblastoma (benign)
Giant cell tumor (benign)

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7
Q

What tumors are found in the metaphysis?

A

Benign:
Osteoblastoma
osteochondroma
osteoid osteoma
chondromyxoid fibroma
giant cell tumor

Malignant:
osteosarcoma
juxtacortical osteosarcoma

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8
Q

What tumors are found in the diaphysis?

A

Benign:
enchondroma
fibrous dysplasia

Malignant:
Ewing sarcoma
chondrosarcoma

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9
Q

Where do Ewing sarcomas occur and what is the percentage of occurrence at each location?

A

41% Lower extremity
26% pelvis
16% chest wall
9% upper extremity
6% spine
2% skull

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10
Q

Where do osteosarcoma occur and what is the percentage of occurrence at each location?

A

29.5% distal femur
14.7% proximal tibia
7.9% proximal humerus
9.1% craniofacial
7.6% pelvis
5.4% proximal femur
5% spine

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11
Q

What is the most common radiation induced sarcoma?

A

Osteosarcoma

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12
Q

What is the Li-Fraumeni syndrome

A

a family cancer syndrome in which there is a germ line mutation of the p53 gene that results in familial sarcomas

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13
Q

What bone diseases are associated with osteosarcomas?

A

Paget’s disease

osteochondromas

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14
Q

What are the most common locations of osteosarcomas?

A

Distal femur

proximal tibia

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15
Q

What are the signs/symptoms of osteosarcoma?

A

Bone pain

swelling

loss of range of motion

fracture

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16
Q

What would you expect the x-ray of an osteosarcoma to look like?

A

“onion skin” associated with a soft tissue mass

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17
Q

What kinds of imaging are used in detection and diagnosis of osteosarcomas?

A

X- rays

CT

MRI

Bone scans

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18
Q

What kind of biopsy is done for osteosarcomas?

A

Core needle or open biopsy

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19
Q

What kind of staging is used for osteosarcomas?

A

The Enneking staging system

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20
Q

What is the Enneking staging system?

A

Enneking:
G1 – Low grade
* G2 – High grade
* T1 – Intracompartmental
* T2 – Extracompartmental
* M0 – No metastases or
nodes
* M1 – Positive metastases or
nodes

American Joint
Commission on Cancer
(AJCC)/ TNM
* T0 – No evidence
* T1 – Less than 8 cm
* T2 – Greater than 8
cm
* T3 – Not available
* N
* M

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21
Q

What modalities are used to treat osteosarcomas?

A

Surgery
-amputation
-limb sparing surgery

Chemotherapy
(neoadjuvant)

Radiation therapy
(for unresectable tumors)

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22
Q

What is the external beam radiation therapy dose for osteosarcomas?

A

64-70 Gy dose

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23
Q

What is the TD 5/5 for bone?

A

70 Gy

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24
Q

At what age range is risk for osteosarcoma highest?

A

ages 10-19 years.

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25
Q

What is the common bone tumor in children age 10-20 years?

A

Ewing’s Sarcoma

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26
Q

The median age of patients with Ewing sarcoma is ______ years, and more than ______% of patients are adolescents.

A

15 years

50

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27
Q

What is the most common location of metastasis in the case of Ewing’s sarcoma?

A

lung

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28
Q

Among bone tumors, Ewing sarcoma is relatively radiosensitive, true or false?

A

True

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29
Q

What are the presenting signs/symptoms of Ewing’s sarcoma?

A

bone pain

mass

limitation of movement

fatigue

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30
Q

What are the treatment modalities used in Ewing’s sarcoma?

A

surgery (best option)

chemotherapy

radiation therapy
-whole bone

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31
Q

What is the external beam radiation therapy dose delivered to Ewing sarcoma tumors?

A

55-60 Gy total at 1.8 Gy/fraction

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32
Q

How many centimeters must be in the margin around Ewing sarcoma primary lesion and soft tissue components?

A

2-3 cm

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33
Q

Why is the non involved epiphysis spared in the treatment of a whole bone with Ewing sarcoma?

A

to reduct late effects

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34
Q

In EBRT treatment of Ewing’s sarcoma, what is done to prevent lymphedema?

A

Sparing lateral strips of tissue to allow lymph drainage

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35
Q

What is multiple myeloma

A

Neoplastic proliferation of plasma cells and accumulation of immunoglobulin secreting cells derived from B-cell lymphocytes

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36
Q

Where are B- cells produced?

A

bone marrow

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37
Q

What is unique about the signs/symptoms of multiple myeloma?

A

Patients may be asymptomatic for years

38
Q

What are the signs/symptoms of multiple myeloma?

A

Bone pain

fracture

blood abnormalities

neuropathy

hypercalcemia

infection

frequent infections

kidney problems

39
Q

What kind of biopsy is done for multiple myeloma?

A

Bone marrow biopsy

40
Q

What is unique about imagining for multiple myeloma?

A

Multiple/many lesions are present (but unknown primary lesion)

Bone scans are not useful in detection

41
Q

What are the treatment modalities used for multiple myeloma?

A

Surgery
-bone marrow transplant

Chemotherapy

Radiation therapy

High dose chemotherapy and radiation delivered prior to stem cell transplantation

42
Q

What is autologous vs. allogenic stem cell transplantation?

A

Autologous: from patient’s own stem cells

Allogenic: from another person’s stem cells

43
Q

What kind of radiation therapy is delivered to multiple myeloma patients?

A

Total Body

44
Q

What external beam radiation therapy dose is delivered to multiple myeloma patients?

A

12 Gy in 6 fractions

(1,200) cGy in 6 fractions

45
Q

What is the goal of radiation therapy in multiple myeloma patients?

A

Destroy cancer cells in areas where chemotherapy can’t easily reach
(nervous system, bones, skin, testes)

To decrease the response of the immune system

To create space for new bone marrow to grow

46
Q

What is the most common form of malignant bone tumor?

A

Metastatic bone disease

47
Q

What are the common associated sites in metastatic bone disease?

A

Prostate

lungs

breast

48
Q

What stage of life are patients usually in with bone mets?

A

Middle aged/ elderly

49
Q

What are bone mets?

A

Painful lytic bone lesions that eat away at bone

50
Q

What are signs/symptoms of bone mets?

A

swelling

anemia

weakness

pathological fractures

compression fractures of vertebrae (can cause spinal cord compression)

Hyperglobulinemia
(disturbance of clotting mechanism)

51
Q

What kind of modality is the best option for metastatic bone tumors?

A

Radiation therapy (palliative)

52
Q

What are other modalities used to treat metastatic bone tumors?

A

analgesics/ steroids

surgery

chemotherapy

hormone therapy

53
Q

What is the most common location of tumors in metastatic bone tumors?

A

T spine (most common)

Long bones

54
Q

In addition to EBRT what is used to treat metastatic bone tumors?

A

Brachytherapy

(STRONTIUM-89)

55
Q

What is the common setup for metastatic bone tumors?

A

supine/prone

single PA field or AP:PA fields

field borders that contain one superior vertebral body and one inferior

56
Q

What is the external beam radiation therapy dose for metastatic bone tumors?

A

800 cGy in a single fraction

or

2000 cGy in 4 fractions

or

3000-4000 cGy in 10-15 fractions

57
Q

Where do soft tissue sarcomas arise from?

A

mesoderm (connective tissue)

58
Q

What are 11 kinds of soft tissue sarcomas?

A

rhabdomyosarcoma

leiomyosarcoma

hemangiosarcoma

kaposi’s sarcoma

lymphangiosarcoma

synovial sarcoma

neurofibrosarcoma

liposarcoma

fibrosarcoma

malignant fibrous histiocytoma

dermatofibrosarcoma

59
Q

What kind of tumor occurs in skeletal muscles most commonly in children?

A

rhabdomyosarcoma

60
Q

What kind of tumor occurs in smooth muscles, most commonly in the uterus, gastrointestinal tract or lining of blood vessels?

A

leiomyosarcoma

61
Q

What kind of tumor affects blood vessels, especially in arms, legs, and trunks?

A

hemangiosarcoma

62
Q

What kind of malignancy occurs in blood vessel walls and often affects people with immune deficiencies such as HIV/AIDS?

A

Kaposi’s sarcoma

63
Q

What kind of tumor affects the lymph vessels and sometimes is seen in a limb with lymphedema, and can be from an area of prior radiation therapy of rare chronic infections?

A

lymphangiosarcoma

64
Q

What kind of tumor affects tissue around joints such as the knees and ankles that typically occurs in children and young adults?

A

Synovial sarcoma

65
Q

What kind of tumor occurs in the peripheral nerves?

A

Neurofibrosarcoma

66
Q

What kind of tumor occurs in fatty tissue, often in legs and trunk?

A

Liposarcoma

67
Q

What kind of tumor is found in the fibrous tissue in arms, legs, or trunk?

A

Fibrosarcoma

68
Q

What kind of tumor affects fibrous tissue most likely to occur specifically in the legs?

A

Malignant fibrous histiocytoma

69
Q

What kind of tumor grows in the tissue beneath your skin and develops in your trunk or limbs?

A

dermatofibrosarcoma

70
Q

Soft tissue sarcomas account for less than _______ of all cancers and _________ of pediatric cancers.

A

1%

15%

71
Q

What is the age characteristic of soft tissue sarcoma epidemiology?

A

Bimodal age groups:

children

adults 50s-60s

72
Q

In soft tissue sarcomas: _______ are generally more affected in limbs whereas _________ tumors are usually found more in the pelvis and neck.

A

adults

pediatric

73
Q

Soft Tissue sarcomas are distributed in these areas of the body by these percentages:

Extremeties?

Gastrointestinal stromal tumors (GIST)?

Retroperitoneal or intra abdominal?

Head and neck?

A

Extremities (60%)

  • Gastrointestinal Stromal Tumors (GIST) (25%)
  • Retroperitoneal or intra abdominal (15-20%)
  • Head and Neck (9%
74
Q

What is the sex epidemiology of soft tissue sarcomas?

A

slight male predominance

75
Q

What is the racial epidemiology of soft tissue sarcomas?

A

No racial significance

76
Q

What genetic anomalies are associated with soft tissue sarcoma epidemiology?

A

Li-fraumeni

Von Recklinghausen’s

77
Q

What environmental exposures are associated with soft tissue sarcomas?

A

phenoxyacetic acid hybercides

ionizing radiation exposure

78
Q

What are symptoms/signs of soft tissue sarcomas?

A

Parasthesia

edema

79
Q

What can cause a delay in diagnosis of soft tissue sarcomas by 4-28 moths?

A

Lack of clinical symptoms

80
Q

What its unique about the growth pattern of soft tissue sarcomas?

A

Tumors grow longitudinally rather than radial

81
Q

What kind of laboratory study is valuable in diagnosing soft tissue sarcomas?

A

Cytogenetics

82
Q

What kind of imaging studies are used in soft tissue sarcomas?

A

CT
-for cortical bone erosion and tumor mineralization

MRI
-provides views of long axis of the limb and in depicting fatty nature of the tumor

Angiography
-demonstrate tumor malignancy on the basis of prominent vascularity

83
Q

How do soft tissue sarcomas spread?

A

Extend locally and spread along paths of least resistance, following muscle sheaths or nerve fibers

84
Q

Soft tissue sarcomas rarely spread through lymphatics except with high grade lesions such as:

A

rhabdomyosarcomas

epithelioid sarcomas

angiosarcomas

85
Q

What is the most common site of metastasis for soft tissue sarcomas?

A

Lung

BUT (tumor and liver, and peritoneum are also common sites in the case of an abdominal tumor)

86
Q

What are the goals of pre-op radiation and post op radiation for soft tissue sarcomas?

A

Pre op:
-shrink the tumor, field size is confined to the tumor only

Post-op
-purpose is to treat extent of microscopic disease after surgery in margins

87
Q

What treatment technique is used with soft tissue sarcomas?

A

Shrinking field technique

88
Q

What immobilization device is used in treatment of bone tumors and soft tissue sarcomas of the extremities?

A

Vac-lok

the extremity is moved as far away from the trunk as possible for better accessibility of the surgical site

89
Q

What immobilization devices are used in the treatment of bone tumors or soft tissue sarcomas of the head and neck?

A

Mask

the area of the tumor may be cut out

90
Q

What are the important things to remember when treating extremities?

A

-entire circumference of the extremity is NEVER irradiated (prevention of lymphedema)

-so a strip of tissue is shielded along at least one margin of treatment volume

-wedges and compensating filters are commonly used

-bolus and or electrons for incision scar used as needed

91
Q

What are the minimum margins for treatments of soft tissue and bone?

A

MUST have:

minimum of 5 cm margin around tumor bed for low grade tumors

minimum of 10 cm margin for high grade tumors

must cover ENTIRE SCAR

92
Q

What is the shrinking field technique?

A

Initial treatment field is treated with a large margin in order to cover the entire scar and tumor bed.

The field is then reduced to only the initial surgical site.

Referred to as SIR (simultaneous integrated boost) in IMRT.

For example, the original large field may be given 50 Gy and the newer reduced field may be given 24 Gy.

Radiation Therapy (26 decks)

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