clinical practice - Lung

Question 1

most appropriate external beam RT treatment for NSCLC:
-Early stage
-locally advanced

Answer 1

-surgery if not fit…SABR

-Chemo RT (66/33#) preferably concurrent+ consolidation IO
- if not fit for concurrent , sequential with accelerated RT (66Gy/24#)

Question 2

most appropriate external beam RT treatment for NSCLC Metastatic:
-Oligometastatic
-More extensive Metastases

Answer 2

-systematic therapy and SABR
-Systemic therapy (TT/IO/CT) and palliative RT if indicated

Question 3

SCLC Early stage/localised disease T1-4 N0-3 M0

Answer 3

-concurrent chemo RT ( sequential if PS is worse)
-Thoracic RT should be initiated asap (during 1st or 2nd cycle of chemo)
-Elective nodal irradiation depends on staging (PET +/- biopsy)

Question 4

SCLC Metastatic disease T1-4 N0-3 M1a/b

Answer 4

-palliative intent
-chemotherapy
-RT is an option after systemic therapy if pt has response and good PS but not always recommended
-PCI recommended if good PS

Question 5

What are the relevant OARS?

Answer 5

-brachial plexus
-oesophagus
-spinal cord
-heart
-lungs

Question 6

DVCs for :
-brachial plexus
-oesophagus
-spinal cord
-heart
-lungs

Answer 6

-Median dose <69 Gy
-V35 <50%
-Dmax = 50
-V25 <10%
- V20 ≤ 30%

Question 7

Volumes and Margins
-3DCT
-SABR/4DCT

Answer 7

-20mm sup/inf and 7mm in all other directions
-5-10mm sup/inf and 5mm in all other directions from ITV

Question 8

what is the target volume

Answer 8

primary lesion and involved nodes

Question 9

what is the :
GTV
CTV
PTV

Answer 9

-primary lesion and all nodes >10mm (PET is preferable for nodes)
-GTV +8mm margin
-CTV +ITV (tumour motion) +set-up error (department specific)

Question 10

Planning:
-isocentre location
-technique

Answer 10

-centre of PTV
-3DCRT

Question 11

Planning:
-BEAM ORTENTAION
-APERTURE
-ENERGY

Answer 11

-combination of anterior , lateral and posterior oblique fields
-conformal MLC w/ margin for pemumbra
-6MV-10MV

Question 12

Don’t use a high energy field for lung

Answer 12

-nothing more than10Mv regardless of path because increased lateral scatter because of the surrounding low density material

Question 13

acute side effects pt1

Answer 13

Skin reaction

Fatigue

Question 14

acute side effects pt 2

Answer 14

Acute radiation pneumonitis:
-bed rest and bronchodilators
-Severe cases->positive pressure oxygen
-Antibiotics only if associated secondary infection

Question 15

acute side effects pt 3

Answer 15

probably secondary to bronchial mucosal irritation. Cough medication to sooth/reduce irritation

Question 16

Depression & Anxiety

Answer 16

• related to poor prognosis
• self-attribution associated with smoking
• often under diagnosed

Question 17

Ensure patients have been screened for psychosocial issues

Answer 17

– Educate patients re available support services
– Listen and support patients/patients family