Dose to sites Flashcards

1
Q

Skin

A

Temp alopaecia 10-15Gy
Faint erythema 14-16Gy
Erythema 20Gy
Dry desquimation 30Gy
Moist Desquimation 40Gy
Permanent alopecia 50Gy

Chronic Telangiectasia TD 5/5: 50Gy to 100cm^2 occurs 1-2yrs post RT

Endpoint: Gangrene, necrosis, and ulceration
55Gy to 100cm^2 leads to endpoint reaction months to years post-treatment. Smaller fields, such as 10cm^2 can tolerate up to 60-70Gy

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2
Q

Cartilage

A

70Gy causes cartilage necrosis months to years post-treatment due to vascular damage

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3
Q

Femoral Heads and Necks

A

TD 50Gy < 50% of volume can cause osteoradionecrosis years to decades after RT

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4
Q

Small Bowel

A

Enteritis 20-25Gy
Diarrhoea 25Gy
Constipation 25Gy

QUANTEC: the volume receiving 45Gy should be less than 195cc for a less than 10% chance of RTOG Grade 3+ toxicity years to months post-treatment

Endpoint: Necrosis, Perforation, and Fistula

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5
Q

Bladder

A

Cystitis, Dysuria, and increased frequency 25Gy

Endpoint: Bladder contracture and volume loss

QUANTEC: A maximum radiation dose of less than 65GY to the whole organ creates a less than 6% chance of Grade 3 late RTOG endpoint months to years post-treatment. Which is severe frequency, dysuria, severe telangiectasia, and frequent haematuria.

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6
Q

Rectum

A

Acute: 20-25Gy
Proctitis
Haematochesia
Diarrhoea
Dyschesia
Rectal Pain

QUANTEC: V50<50%, V60<35%, V65<25%
less than 10% chance of a RTOG grade 2/3 late rectal toxicity months to years post-treatment

Grade 3: Obstruction or bleeding
Endpoint: Severe proctitis, fistula, stenosis, necrosis

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7
Q

Anus

A

Acute:
Inflammation and moist desquamation of the skin

Endpoint: Chronic ulcers, loss of sphincter function, and stenosis

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8
Q

Penile Bulb

A

QUANTEC: 50Gy to 90% of the gland creates a less than 35% chance of severe erectile dysfunction months to years post-treatment

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9
Q

Ovaries

A

Acute: Persistent amenorrhea 2Gy
Endpoints: Permanent sterility 2.5Gy

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10
Q

Vagina

A

Acute:
Vaginal adhesions 10Gy
Vaginitis 30Gy

Endpoint: Ulcer, fistula, fibrosis

120Gy - upper vagina
80-90Gy mid vagina
60Gy to lower 1/3

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11
Q

Testes

A

Acute: transient aspermia 0.5Gy
Endpoint: Permanent sterility 1.5Gy

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12
Q

Stomach

A

Acute: Gastritis 10-20Gy

QUANTEC: 45Gy to the whole organ for a less than 7% chance of ulceration, mucosal erosion, and perforation months to years post-treatment

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13
Q

Kidneys

A

QUANTEC: For bilateral kidneys the volume receiving 28Gy should be less than 20% this creates less than 5% chance of clinical dysfunction months to years post-treatment

Endpoint: Nephritis and kidney failure

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14
Q

Liver

A

Acute:
Jaundice, Anorexia, and Fatigue 20-25Gy
Acute radiation hepatitis and ascites 25Gy

Endpoint:
Veno-occulsive disease
Radiation-induced liver disease for which there is a less than 5% chance of occurring 2-3 weeks post-treatment if the liver is partially irradiated to 30-32Gy

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15
Q

Spleen

A

Acute: Blood counts altered and poor immune function 30-40Gy

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16
Q

Oesophagus

A

Acute: Oesophagitis reaulting in dysphagia 20Gy
QUANTEC: A mean dose of less than 34Gy creates a 5-20% chance of RTOG Grade 3+ oesophagitis (severe dysphagia)

Endpoint:
At 55Gy there is an increased risk of stricture, ulceration/perforation, and fistula during RT or months post-treatment

17
Q

Heart

A

Acute:
20Gy asymptomatic pericarditis
40Gy acute pericarditis

QUANTEC: 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

Endpoint: Late myocardial infraction and fibrosis leading to reduced output

18
Q

Ribs

A

Endpoint:
50Gy to partial rib leads to osteoradionecrosis leading to pathologic fracture years post-treatment

19
Q

Breast

A

Acute: radiation-induced dermatitis
Chronic: Telangiectasia
Endpoint: Fibrosis causing ulceration and atrophy causing a small hard breast, with doses up to 60GY years post-treatment

20
Q

Brachial Plexus

A

The 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. The max dose should not exceed 66Gy with a conventional fractionation schedule

21
Q

Lung

A

Acute: acute pneumonitis
Endpoint: Chronic radiation pneumonitis

QUANTEC: for the combined lungs a V20<_30% gives a less than 20% chance of symptomatic

22
Q

Spinal Cord

A

Acute: Lhermitte’s syndrome 35Gy
Endpoint: Radiation-induced myelitis necrosis leading to paralysis and incontinence, C spine irradiation may cause death
QUANTEC: A maximum dose of 50Gy to a partial organ creates a less than 0.2% chance of endpoint reaction with 3D-CRT

23
Q

Larynx

A

Acute:
Laryngitis
Dysphagia and dysphonia (hoarse voice)
Laryngeal oedema (inflammation and swelling) and voice changes 45Gy, permanent doses greater than 60Gy

Treatment:
Gargle aspirin
Lignocaine Viscus Gel
Soft foods
Ensure plus for weight loss
Nasogastric tube
P.E.G.

QUANTEC: a dose of less than 66Gy within the organ creates a less than 20% chance of vocal dysfunction months post-treatment

Endpoint: chronic laryngitis and necrosis, 70Gy causes cartilage necrosis months to years post-treatment due to vascular damage

Treatment:
Pain medication
Surgical intervention
Speech therapy

24
Q

Parotid Gland

A

Acute: temporary xerostomia (no saliva) and increased risk of tooth decay and gum disease 10-20Gy

Treatments:
Sipper bottle of water
Artificial saliva
Soft/moist foods
Dental prior

QUANTEC:
Bilateral whole parotid glands: a mean dose of less than 25Gy for the combined parotids creates a less than 20% chance of long-term salivary function of less than 25%

Unilateral whole parotid gland: a mean dose of 20Gy for a single parotid creates a less than 20% chance of long-term salivary function in the affected parotid of less than 25%

25
Q

Mucosa (Lips, Mouth, and Pharynx)

A

Acute:
Mucositis (inflammation of mucosa) and stomatitis (inflammation of the mouth and lips) 20Gy: gargle aspirin and avoid alcohol, spicy foods, and smoking
Yeast infection and ulceration 30Gy: nystatin

Chronic: Mucosal atrophy (inflammation and thinking), ulceration, and telangiectasia

Endpoint: Fibrosis and necrosis from 60Gy years post-treatment

26
Q

Thyroid Gland

A

30Gy
Side effects are functional problems: thyroid replacement hormones

27
Q

Mandible

A

40-50Gy
Endpoint: Radiation-induced osteoradionecrosis leading to pathological fracture due to vascular damage and trauma years to decades post-treatment - possibility of a bone graft

28
Q

Lens

A

4Gy
Endpoint: cataracts developing years post-treatment for which the treatment is surgical removal

29
Q

Retina

A

45Gy
Endpoint: retinopathy leading to blindness weeks to months post-treatment for which there is no treatment

30
Q

Lacrimal Gland

A

30Gy
Endpoint: loss of tears leading to dry eyes, and ulceration weeks to months post-treatment
Treatment: artificial tears/lubricating eye drops

31
Q

Facial Muscles (Pterygoid Muscle)

A

TD: 5/5: 60Gy
Endpoint: Trismus (muscle spasm)
Treatment: muscle relaxant and physiotherapy

32
Q

External and Middle Ear

A

Acute: Acute serous otitis (painful fluid buildup in the middle ear) and tinnitus (ringing) at 30Gy
Treatment: anti-inflammatory ear drops and pain relief

Endpoint: chronic serous otitis and tinnitus at 45Gy which can occur months to years post-treatment
Treatment:
anti-inflammatory ear drops
pain relief

33
Q

Brain

A

Acute 2Gy:
Encephalitis (inflammation in the brain) causes swelling, headaches, nausea, and vomiting - treated with paracetamol, ibuprofen, and dexamethasone (helps with swelling)
Nausea and vomiting by encephalitis putting pressure on the hypothalamus (central brain) - treated with strong antiemetics such as ondansetron (chemo-induced nausea)
Fatigue

Chronic: memory impairment, somnolence (drowsiness), headache, seizures, and sometimes cognitive problems

QUANTEC: maximum radiation doses of less than 60Gy within the brain create a less than 3% chance of symptomatic necrosis (occurs months to years post-treatment) for which there is no treatment.
Symptoms of radionecrosis depend on the location and function of the brain at the injury site. Can range from headaches, fatigue, nausea, imbalance, extremity weakness/numbing, speech deficits, and seizures

Endpoint: Necrosis and infarction (obstruction of the blood supply to the organ or regions of tissue) occurs months to years post-treatment, for which there is no treatment

34
Q

Brain Stem

A

QUANTEC: A maximum radiation dose of less than 54Gy within the whole organ creates a less than 5% chance of the endpoint reaction occurring

Endpoint: neuropathy (nerve damage leading to pain or weakness) or necrosis which can occur months to years post-treatment, for which there is no treatment

35
Q

Optic Nerve

A

QUANTEC: A maximum radiation dose of less than 55Gy within the organ creates a less than 3% chance of endpoint reaction

Endpoint: optic neuropathy leading to blindness in associated eye months to years post-treatment, for which there is no treatment

36
Q

Optic Chiasm

A

QUANTEC: A maximum radiation dose of less than 55Gy within the whole organ creates a less than 3% chance of the endpoint reaction

Endpoint: optic neuropathy leading to blindness in both eyes months to years post-treatment, for which there is no treatment

37
Q

Pituitary Gland

A

46Gy to the shole structure, normal function becomes suppressed, and treatment is hormone replacement therapy