Clinical practice - Prostate Flashcards

1
Q

external beam RT treatment

A

volumetric modulated arc therapy (VMAT)

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2
Q

justification for VMAT

A

-Precision: VMAT focuses the radiation on the tumor while sparing healthy tissue.

-Speed: takes around 2 mins. Faster treatments improve the accuracy of radiation delivery

– Improved sparing with OAR doses

– Consistent and significant reduction in Monitor Units

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3
Q

features of VMAT

A

– Either single or double arc
– Can also be partial arc
– 6MV is standard

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4
Q

IGRT @ the linac: DEFINITIVE

Possible match structures

A

– Fiducials
– Sof tissue (prostate gland)
– Bone – Used but not recommended practice

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5
Q

IGRT @ the linac: POST PROSTATECTOMY

Possible match structures

A

-Bone
– Surgical clips – area of current research

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6
Q

target volumes

A

Prostate CTV-The entire prostate gland as defined on planning CT with aid of MRI

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7
Q

Target Dose: Post Op Radiotherapy

A

– Adjuvant 60-64Gy

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8
Q

Target Dose: Lymph Node Irradiation

A
  • 80Gy in 40fx to prostate and SVs @ 2Gy/fx
  • 60Gy in 40fx to LN @ 1.5Gy/fx
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9
Q

dose volume constraints =

A

Bladder= V65<50%, V70<35%, V75<25%, V80<15%

Femoral Heads= V50<5% (NB: this was taken from RTOG not QUANTEC)

Small Bowel = When contoured as a bowel bag V45<195cc

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10
Q

VERIFICATION

A

-

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11
Q

imaging verification protocol

A

Daily online IGRT – matching to the prostate
if matching to prostate -3D (CBCT)
if matching to Fiducials (2D KV orthogonal or 3D (CBCT)

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12
Q

2D KV orthogonal field Matching to Fiducials

A
  • Orthogonal KV images to match in all three directions
  • “Best fit” may be required
  • Placement of fiducials is important – at least 3 inserted
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13
Q

KV imaging limitation

A

-not possible to assess rectal or bladder volumes , but if rectum is inconsistent there should be larger discrepancy between bone and fiducal

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14
Q

Post prostatectomy with implanted fiducials

A

CBCT match to bone initially then manually adjust to match fiducials

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15
Q

features of 2D KV orthogonal imaging

A

-prostate cant be seen
-imaging dose lower
-image acquisition quicker

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16
Q

features of 3D CBCT

A

prostate can be seen
rectum and bladder can be seen

17
Q

even though CBCT is indicated however…

A

-correlation between soft tissue and bone is good 2D KV orth may be sufficient
-patient may have consistent bladder and rectum volume - reason for CBCT may be reduced

18
Q

SIDE EFFECT. MANAGEMENT

A
19
Q

management advice for Diarrhoea

A

-Ensure adequate fluid intake to avoid dehydration
-Avoid foods that may aggravate the problem (fatty or spicy foods)
-Anti-diarrhoeal agents may be prescribed

20
Q

management advice for Dysuria (pain when pee) and frequency

A

-Decrease fluid intake late at night
-Non-steroidal anti-inflammatory drugs (NSAIDs)

21
Q

management advice for fatigue

A

Evidence demonstrates the positive impact of exercise

22
Q

management advice for PR bleeding/mucous and rectal
discomfort
Proctitis

A

-Buscopan
-Anusol
-Corticosteroid suppositories

23
Q

management advice for Dermatitis

A

-Good hygiene with gentle washing
-E45 cream – no soaps or rubbing

24
Q

holistic care

A

– The importance of open communication
– Role of support groups
– Resources available to alleviate stress e.g: community transport