CNS

Question 1

Glioma Treatment Volumes Low and High Grade

Answer 1

low grade: 1-2cm around GTV

High grade: 2-3cm around GTV

Question 2

Meningioma Treatment Volumes Benign and malignant

Answer 2

Benign: 1cm
Malignant: 3cm

Question 3

Primary Spinal cord volume

Answer 3

width of post fields 7-8cm
5cm for children

1-2 vertebral bodies above and below

Question 4

Motor speech area of the brain

sensory speech area of the brain

what is the circle of willis

Answer 4

Broca

Wernicke

Supplies blood to brain

Question 5

Meningioma Dose

Answer 5

Unresectable or recurrent benign : 5040-54
Atypucal: 54-60
malignant: 60

Question 6

Lymphoma dose

Answer 6

2340-3600

Question 7

Primary Spinal cord dose

Answer 7

Intramedullary, ependymoma and astrocytoma
-5040

high grade: 54
SBRT: 10-16

Question 8

Glioma Dose

Answer 8

RT used for post op, high grade tumours, residual disease, high risk

EBRT, sterotactic or brachy
45-60

low grade 50-54

high grade 60

Question 9

Locations of tumours and how they affect patients

Frontal

Answer 9

Short term memory loss, episodes of falling or difficulty walking, personality changes, mood changes, moto skills, hemi-paralysis, seizure, drowsiness’, decrease attention

Question 10

Locations of tumours and how they affect patients

Temporal

Answer 10

Loss of memory, difficulty with hearing, loss of smell, exhibiting signs of not being able to understand and comprehend directions, proptosis

Question 11

Locations of tumours and how they affect patients

Parietal

Answer 11

Controls sensations, loss of memory, difficulty with hearing

Question 12

Locations of tumours and how they affect patients

Occipital, Cerebellum and cerebrum

Answer 12

sudden loss of eye sight in one eye

Balance, movement, balance (ataxia)

Temperature, Unilateral weakness and mental changes

Question 13

Glioma Pathology

Answer 13

MC are gliomas–>can start in the brain or spine

main type of glioma

• astrocytoma
• ependymoma
• oligodendoglioma

Question 14

Meningioma pathology

Answer 14

Benign (Grade I) 90%
Fibrous + transitional
Atypical (Grade II) <10%
Anaplastic/malignant (Grade III) <5%

Question 15

Lymphomas pathology

Answer 15

Most are large diffuse B cells lymphoma
-T cell more aggressive and poorer prognosis

Common to have more than one tumour present

Question 16

Primary Spinal Tumour

Answer 16

Mostly are benign but are problematic

• Extramedullary
• Intramedullary

Question 17

Prognostic indicators for:

1. Gliomas
2. meningioma
3. lymphomas
4. primary spinal cord

Answer 17

1. High grade
2. Location of lesion
3. AGE!!
4. tumour type

Question 18

Epi/Eti for

1. Gliomas
2. meningioma
3. lymphomas
4. primary spinal cord

Answer 18

1. increase with age (40-80)
   environment + occupational factors
2. sporadic, more common in women (benign), family history and RT to scalp
3. immunocompromised like HIV
4. most intramedullary are astrocytomas or ependymoma. TSpine

Question 19

S&S + MC site for

1. Gliomas
2. meningioma
3. lymphomas
4. primary spinal cord

Answer 19

1. dependent on location
   mc location is in cerebrum (supratentorial)
   always grow back
2. Asymptomatic-location based
   -localized headaches & seizures
   usually benign
3. dependent on site-tumours are often deep an cause seizure
   MC location is cerebrum (supratentorial)
4. Pain-localized to involved region
   numbness/weakness

Question 20

In general…

1. S&S
2. prognostic indicators
3. Medications
4. Dose rage

Answer 20

1. head aches
2. Pathology/types of tissues involved
3. Dexamethazone/Decadrom: swelling
   Temozolomide: Radiosensitizer chemo agent
4. 45-60Gy (200/fx)

Question 21

Spine Tx volume

Answer 21

width for post fields 7-8cm (5cm for children)
1-2 vertebrae above and below
cervical lesions 4-6MV
T+L spine 10-23MV