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Errthing > KU oral boards > Flashcards

KU oral boards Flashcards

1
Q

GBM: RT fields and dose

A

CTV 46Gy - T2 + 2cm

CTV 60Gy - T1 post / cavity + 2cm

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2
Q

GBM: temozolomide dosing during/after RT

A

during RT: 75mg/m2 daily

after RT: 150-200mg/m2 days 1-5 on q28day cycle for 6 months

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3
Q

GBM: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses

A 
chiasm 55Gy
brainstem 60Gy
optic nerves 55Gy
retina 50Gy
lenses 7Gy
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4
Q

GBM: RT options for elderly or poor KPS

A

Roa - 40Gy/15fxs, age > 60 and KPS > 50
Bauman - 30Gy/10fxs, age > 65 and KPS < 50
(French trial showed improved MS with RT compared to observation)

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5
Q

Anal T2-4N0: RT fields and dose

A

CTV 45 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliac
CTV 54 - GTV + anal canal + 2.5cm (consider 60Gy if T4)
PTV - 1cm margin

may do 42Gy/50.4G for T2N0

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6
Q

Anal N+: doses

A

45Gy to elective nodal regions
50.4Gy to nodal regions with nodes <3cm
54Gy to primary and nodal regions with nodes >3cm

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7
Q

Anal: chemotherapy

A

two cycles at a 4 week interval:
5FU 1000mg/m2 daily x 4 days
mitomycin 10mg/m2 x 1 day

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8
Q

Anal: workup

A

H&P: LN eval, DRE, anal sphincter tone, sexual history, HIV, HPV, IBD history, Gyn exam

Labs: CBC, HIV if risk factors

Proctoscopy with bx. FNA of inguinal nodes. MRI or EUS.

CT/MRI of A/P. CXR or CT chest

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9
Q

Rectal: criteria for WLE

A

T1, <3 cm, <30% circumference, margins >3mm, within 8 cm of anal verge, grade 1-2, no LVSI/PNI

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10
Q

Rectal: RT fields and dose (T3-4 or N+)

A

CTV 45 - mesorectum, presacrals, internal iliacs, obturators

CTV 50.4 - tumor/mesorectum + 2cm sup/inf

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11
Q

Rectal: 2D fields

A

AP: L5/S1 down to bottom of obturator foramen or 3 cm below tumor, whichever is more inferior (anal verge for tumors close to anal verge), lat 2 cm on pelvic brim

lat: want ant behind pubic symphysis and 3cm in front of sacral promontory, post 1cm behind sacrum

If T4 with anterior structure invasion - move ant border in front of sacrum

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12
Q

Rectal: chemotherapy

A

preop with concurrent capecitabine 825mg bid M-F

adjuvant treatment for T3/4 or N+ is FOLFOX x 6 months

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13
Q

what are the components of FOLFOX

A

leucovorin (FOLinic acid)
5FU
Oxaliplatin

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14
Q

definition of anal margin

A

area below anal verge encompassing 6cm of skin around anus, consists of keratinizing epithelum

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15
Q

definition of anal verge

A

area near end of anus where nonkeratinizing epithelium becomes keratinizing epithelium

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16
Q

anal cancer target coverage

A

primary PTV: 90/100
nodal ptv: 85/100
max dose 115%

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17
Q

anal cancer constraints for small bowel, bladder, and femoral heads

A

small bowel: V45 < 200cc, Dmax 50Gy
bladder: V50 < 5%
femoral heads: V44 < 5%

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18
Q

rectal cancer constraints for small bowel, and bladder

A

small bowel: V45 < 200cc, Dmax 50Gy

bladder: mean < 40Gy

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19
Q

rectal cancer pCR rate

A

15-20%

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20
Q

treatment paradigm for T1-2 rectal cancer not meeting criteria for WLE

A 
surgical resection (APR/LAR with TME)
give adjuvant CRT for pT3-4 or N+
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21
Q

concurrent chemo for esophageal cancer

A

weekly taxol 50 and carbo AUC 2

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22
Q

esophageal cancer OAR constraints per RTOG 1010 (lung and heart)

A

lung V5 < 50, V20 < 25

heart V40 < 50, mean < 30

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23
Q

criteria for very low risk prostate cancer

A

GS 6 in 1-2 cores, <50% of core,

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24
Q

contraindications to prostate brachy

A

AUA score > 12, size >60cc or <30cc, prior TURP, large median lobe, prior RT, inflammatory bowel disease

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25
Q

prostate brachy dose, energy, half-life for I-125 and Pd-103

A

I-125: 144Gy, 0.028MeV, 60 days

Pd-103: 125Gy, 0.021MeV, 17 days

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26
Q

dosimetric criteria for prostate brachy with modified peripheral loading (D90, V100, V150, V200, urethral Dmax, urethral Dmax, rectal D2cc)

A 
D90 > 90% (goal of 130%)
V100 > 98%
V150 < 40%
V200 < 10%
urethral Dmax < 120
rectal D2cc < 100%
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27
Q

treatment options for stage I seminoma

A

OBSERVATION (preferred)
carbo AUC 7 x 1 cycle
RT

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28
Q

stage IIA/B seminoma dose(s) and field

A

20Gy/10fxs with 10Gy boost to IIA nodes (<2cm) or 16Gy boost to IIB nodes (2-5cm)

field is modified dog leg

superior: top of T12
inferior: top of acetabulum

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29
Q

seminoma kidney constraints

A

single kidney D50 < 8Gy

bilateral kidney mean dose < 9Gy

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30
Q

criteria for bladder preservation

A

T2-T4a, no hydronephrosis, no extensive CIS, able to undergo maximal TURBT

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31
Q

Sedlis criteria for postop cervix

A

need two:
LVSI
size > 4cm
stromal invasion > 2/3

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32
Q

Peters criteria for postop cervix

A

positive nodes, positive margins, parametrial invasion

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33
Q

components of radical hysterectomy

A

mobilization of ureters, bladder, and rectum , dissect parametria out to pelvic sidewall, remove upper half of vagina

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34
Q

postop cervix dose and fields

A

45Gy/25fxs EBRT + vaginal cuff HDR 5Gy x 2 to surface

field: L4/5 to bottom of obturator foramen, 2cm on pelvic brim, anterior border in front of pubic symphysis, posterior covers entire sacrum

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35
Q

definitive cervix dose and fields

A

45 Gy in 25 fx with 4-field, inf at least 3 cm below disease or upper 2/3 vag, as well as HDR with tandem and ovoids with a dose of 6 Gy x 5 (5x6 Gy for EQD2 of 84) = 80-90 Gy to Point A. Treatments delivered 1-2 times per week Rx to point A. Boost gross nodes to 60 Gy.

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36
Q

definitive cervix whole pelvic fields

A

L4/L5 to bottom of obturator foramen or 3 cm from lowest vaginal involvment, 2 cm on pelvic brim, ant is in front of pubic symphysis, post covers whole sacrum with extra 1 cm to cover uterosacral ligaments

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37
Q

definitive cervix fields for positive PA nodes

A

PA nodes: If node positive, include periaortic node chain up to T11/T12. In current 0724 protocol, if common iliac nodes are positive then PA nodes are treated up to L1/L2. If PA nodes are positive, treated up to T11/T12.

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38
Q

tandem and ovoid OAR constraints for bladder, rectum, and sigmoid (45Gy/25 EBRT + 30Gy/5fx HDR)

A

bladder: 90Gy EQD2, 6Gy per fx
rectum: 75Gy EQD2, 5Gy per fx
sigmoid: 75Gy EQD2, 5Gy per fx

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39
Q

inoperable endometrial cancer staging

A 
Stage IA <8 cm uterine cavity sound
Stage IB >8 cm
Stage II involves corpus and cervix
Stage III parametrium, vagina, adnexa
Stage IV
   A local structures
   B metastatic
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40
Q

describe tandem and ovoid procedure

A

I would take the patient to the OR place them in the dorsal lithotomy position and administer general anesthesia. I’d perform and EUA to assess response. After prepping the patient with betadine, a gold seed would be placed at the anterior cervix. A foley catheter would then be inserted to drain the bladder and the foley bulb inflated with 7cc half saline half contrast. I would inject 200 mL of saline into the bladder and clamp the foley. The uterus would be sounded to assess distance to the fundus and flexion, and the appropriate tandem inserted with the largest ovoids that could be accommodated. Packing would be placed anteriorly and posteriorly to the device with gauze soaked with contrast and clindamycin ointment to pack away from the bladder and rectum. I would then take AP and lateral orthogonal films to ensure adequate positioning and packing.

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41
Q

nasopharynx CTV structures

A 
nasopharynx
anterior 1/3 of clivus
foramen rotundum and ovale
pterygoid fossa
parapharyngeal space
inferior sphenoid sinus
cavernous sinus
posterior nasal cavity
posterior maxillary sinus
inferior soft palate
retropharyngeal lymph nodes
retrostyloid space
II-V neck (Ib if ipsi node positive)
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42
Q

criticisms of Intergroup Al-Sarraf trial

A 
non-endemic population
older staging system
pre-IMRT
poor outcomes in RT-alone arm
poor performance status
poor protocol adherence
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43
Q

nasopharynx workup

A

MRI
audiology, ophthalmology consults
EBV titer (PCR)

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44
Q

nasopharynx DVH criteria

A

95% of PTV receives Rx dose, 10% hotspot allowed in up to 20% of the PTV

true brainstem max dose 54 Gy, PRV 1% 60 Gy
spinal cord max dose 45 Gy
chiasm/optic nerves 50 Gy (PRV 54 Gy)
mandible 70 Gy (<1cc 75 Gy)
brachial plexus max 66 Gy

Temporal lobes max<60 Gy

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45
Q

nasopharynx chemo

A

Cisplatin 100mg/m2 q3wk concurrent then adj cis 80 and CI 5FU 1000 x 3 cycles

46
Q

nasopharynx 5yr OS

A

65-70%

47
Q

general H&N workup

A

“H&P: Symptoms. Assess social support, smoking, alcohol. head and neck exam, note teeth condition, cranial nerves, mirror and flex laryngoscopy (esp for larynx), palpation of mass in mouth

FNA biopsy of node if possible

Labs: CBC, Chem7, TSH

Primary Imaging: CT of the neck, possible MRI
Staging Imaging: CT chest, PET for stage III-IV (i.e. T3 or N1 or above)

Special imaging: DL with biopsies, consider videostrobe

Special workup: dental, port, PEG tube, nutrition, (audiology), speech and swallowing evaluation”

48
Q

T1N0 larynx simulation

A

“Supine with chin extended, no stent or shoulder pull, aquaplast mask, CT sim

bolus over anterior if anterior commisure involement”

49
Q

T1N0 larynx 2D field border

A

“Opposed laterals, bolus if lesion is anterior

sup=thyroid notch
inf=bottom of cricoid
ant=flash
post=ant vertebral bodies

rotate gantry to make posterior border non-divergent or place isocenter at anterior edge of vertebral body?”

50
Q

T1N0 larynx surgical options

A

Surgical options = total laryngectomy, vertical hemilaryngectomy (removes 1.3 true cord, one fals cord, 1/2 thyroid cartilage, ipsi arytenoid, inferior tissues for 8-9mm, cordectomy

51
Q

staging: T2 larynx

A

impaired cord mobility, tumor involves supraglottis or subglottis

52
Q

staging: T3 larynx

A

vocal cord fixation, invading paraglottic space or inner cortex of thyroid cartilage

53
Q

5yr OS for T1 and T2 larynx

A

T1 - 80%

T2 - 65%

54
Q

advanced larynx target volumes

A

CTV70 - grass disease with 5mm margin
CTV60 - entire larynx and involved nodal levels
CTV54 - elective nodal levels (I-VI)

55
Q

advanced larynx DVH

A 
PTVs receive 95/100, 99/93
brain stem max 54
spinal cord max 50
parotid mean < 26%, 50% < 30
cochlea mean <45
oral cavity mean < 39
56
Q

endometrial - regimens for VBT only

A

6Gy x 5 to surface

7Gy x 3 to 5mm depth

57
Q

group stage for T3N0 breast

A

IIB (T2N1 or T3N0)

58
Q

group stage for T2N2 breast

A

IIIA (T3N1 or T1-3N2)

59
Q

group stage for T4N0 breast

A

IIIB (T4N0-2)

60
Q

T2 pancreas

A

> 2cm, confined to pancreas

61
Q

N2 esophagus

A

3-6 nodes

62
Q

group stage for T2N1 esophageal adeno

A

IIB (T3N0 or T1-2N1) 3 points

63
Q

group stage for T1N2 esophageal adeno

A

IIIA (T1-2N2, T3N1, T4N0) 4 points

64
Q

group stage for T3N2 esophagus

A

IIIB 5 points

65
Q

N2 anal cancer

A

unilateral internal iliac nodes and/or unilateral inguinal nodes

66
Q

group stage for T1-3N1 anal cancer

A

IIIA (T1-3N1, T4N0)

67
Q

N2a vs N2b rectal cancer

A

N2a 4-6 nodes

N2b 7+ nodes

68
Q

stage IIIA rectal cancer

A

T1-2N1 or T1N2a

69
Q

N1 bladder

A

single lymph node in true pelvis

70
Q

N2 bladder

A

multiple lymph nodes in true pelvis

71
Q

N3 bladder

A

common iliac nodes

72
Q

stage III bladder

A

T3N0 or T4aN0 (positive nodes are stage IV)

73
Q

IB2 cervix

A

clinically visible lesion more than 4cm

74
Q

IIA2 cervix

A

lesion >4cm involving upper vagina

75
Q

IIB cervix

A

parametrial invasion

76
Q

IIIA cervix

A

involves lower vagina

77
Q

IIIB cervix

A

pelvic wall or hydronephrosis

78
Q

II uterus

A

cervical stromal invasion

79
Q

IIIA uterus

A

serosa or adnexa

80
Q

IIIB uterus

A

vagina or parametrium

81
Q

IIIC1 uterus

A

pelvic nodes

82
Q

IIIC2 uterus

A

paraaortic nodes

83
Q

IB vulva

A

> 2cm in size or >1mm DOI

84
Q

II vulva

A

distal urethra, distal vagina, anus

85
Q

IIIA vulva

A

1-2 nodes < 5mm OR 1 node > 5mm

86
Q

IIIC vulva

A

extracapsular extension

87
Q

T4a larynx

A

invades through thyroid cartilage and/or invades soft tissues beyond larynx

88
Q

T2 oropharynx

A

2-4cm

89
Q

T4a oropharynx

A

larynx, deep tongue muscles, medial pterygoid, hard palate, mandible

90
Q

group stage for T4aN2 H&N

A

IVA

91
Q

group stage for T3N0 or T1-3N1 H&N

A

III

92
Q

group stage for N3 H&N

A

IVB

93
Q

T3 nasopharynx

A

invades bone or paranasal sinuses

94
Q

T2 NSCLC

A

3-7cm, involving main bronchus >2cm from carina, visceral pleura, lobar atelectasis

95
Q

T3 NSCLC

A

> 7cm, parietal pleura, chest wall, diaphragm, phrenic nerve, main bronchus <2cm from carina, atelectasis of entire lung, separate tumors in same lobe

96
Q

components of stage IIIA NSCLC

A

T1-3N2, T3N1, T4N0-1

97
Q

components of stage IIIB NSCLC

A

any N3 or T4N2

98
Q

Masaoka T2b

A

invasion of surrounding fatty tissue or mediastinal pleura

99
Q

Masaoka T3a

A

invasion of neighboring organs excluding great vessels

100
Q

Masaoka T3b

A

invasion of great vessels

101
Q

lung 5 fraction SBRT dose constraints (cord, lung, everything else)

A

cord - 30Gy
lung - V20 < 10%
everything else - 105% of prescription dose

102
Q

lung 3 fraction SBRT dose constraints (cord, lung, esophagus, heart, trachea/bronchus)

A 
cord - 18Gy
lung - V20 < 10%
esophagus - 27Gy
heart - 30Gy
trachea/bronchus - 30Gy
103
Q

NSCLC RTOG 0617 chemo regimen

A

RTOG 0617: weekly carbo AUC 2 and paclitaxel 45mg/m2, then adjuvant 2 cycles carbo AUC 6 and paclitaxel 200 mg/m2

104
Q

advanced NSCLC DVH

A

PTV 95/100, max 120%

OARs (in order of importance):
cord<45
lungs V20<35%, MLD<20, V5<70%
plexus <66 Gy
esophagus mean <34 Gy
heart V40<50%
105
Q

NSCLC concurrent cis/etoposide doses

A 
cisplatinum 50 (days 1, 8, 29, 36)
etoposide 50 (days 1-5, 29-33)
106
Q

LS-SCLC chemo doses

A

cis/etop 60/120 q4 weeks for 4 cycles

107
Q

thymoma indications for adjuvant RT

A

R1-2 resection, stage III-IV

108
Q

thymoma doses for R1, R2, and definitive

A

R1 - 54Gy
R2 - 60Gy
definitive - 70Gy

109
Q

Deauville criteria

A
  1. No uptake above background
  2. Uptake ≤MS
  3. Uptake >MS but ≤liver
  4. Uptake moderately >liver
  5. Uptake markedly&raquo_space;liver

4 and 5 are always positive. In some situations, 3 is considered positive.

110
Q

adjuvant pancreas classic fields

A

9704 field borders - T11 to L3, 2 cm margin on tumor, 2 cm from R vertebral body (includes hepatic hilum, pancreatic remnant, and 1.5-2.0 cm from vertebral bodies to cover periaortics). Laterals: posterior border split vertebral body, ant border 2 cm in front of mass and block out small bowel if able. “

111
Q

vulvar cancer indications for adjuvant RT

A

Heaps criteria - close margin (8mm), DOI > 5mm, LVSI

Node positive

Errthing (12 decks)

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