Chest and Breast Reactions/doses

Question 1

Cancers of the chest

Answer 1

respiratory structures: trachea, bronchi & lungs
Oesophagus
Breast
Thymus gland (rare)

Question 2

Breast cancer types

Answer 2

Ductal carcinoma in situ (non-invasive)
Invasive ductal carcinoma
Invasive lobular carcinoma
Inflammatory breast cancer

Question 3

Oesophagus acute side effects

Answer 3

Oesophagitis resulting in dysphagia - 20Gy

Question 4

Oesophagus QUANTEC

Answer 4

mean dose of less than 34Gy creates a 5-20% chance of an RTOG grade 3+ oesophagitis

Question 5

Oesophagus endpoint

Answer 5

At 55Gy there is an increased risk of stricture, ulceration, and fistula during RT or post treatment

Question 6

Heart acute side effects

Answer 6

asymptomatic pericarditis 20Gy

acute pericarditis resulting in chest pain and shortness of breath 40Gy

Question 7

Heart QUANTEC

Answer 7

When considering the whole heart, the volume receiving 25Gy should be less than 10% which creates a less than 1% chance of long term cardiac mortality

Question 8

Heart endpoint

Answer 8

Late myocardial infarction and fibrosis leading to reduced output

Question 9

Ribs endpoint

Answer 9

Osteoradionecrosis leading to pathologic fracture years post treatment

Question 10

Breast acute side effects

Answer 10

Radiation induced dermatitis

Question 11

Breast chronic side effects

Answer 11

Telangiectasia

Question 12

Breast endpoint

Answer 12

Fibrosis causing ulceration and atrophy causing a small hard breast that sits high on the chest wall with doses up to 60Gy years post treatment.

Question 13

Brachial Plexus

Answer 13

Volume receiving 60Gy should be less than 5% to create the endpoint reaction of nerve damage leading to brachial plexopathy months to years post treatment

Question 14

Lung acute side effects

Answer 14

Acute pneumonitis causing dry cough and shortness of breath

Question 15

Lung endpoint

Answer 15

Chronic radiation pneumonitis and fibrosis causing decreased lung capacity leading to hypoxia

Question 16

Lungs QUANTEC

Answer 16

For the combined lungs a V20≤30% gives less than 20% chance of symptomatic pneumonitis

Question 17

Spinal cord acute/chronic side effects

Answer 17

Lhermittes syndrome (electrical sensation in limbs) 35Gy

Question 18

Spinal cord QUANTEC

Answer 18

Maximum dose of 50Gy (partial organ) gives a less than 0.2% chance of the endpoint reaction with 3D-CRT

Question 19

Spinal cord endpoint

Answer 19

Radiation induced myelitis necrosis leading to paralysis and incontinence (not death for T spine)