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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
prostate brachy dose, energy, half-life for I-125 and Pd-103
I-125: 144Gy, 0.028MeV, 60 days | Pd-103: 125Gy, 0.021MeV, 17 days
26
dosimetric criteria for prostate brachy with modified peripheral loading (D90, V100, V150, V200, urethral Dmax, urethral Dmax, rectal D2cc)
``` D90 > 90% (goal of 130%) V100 > 98% V150 < 40% V200 < 10% urethral Dmax < 120 rectal D2cc < 100% ```
27
treatment options for stage I seminoma
OBSERVATION (preferred) carbo AUC 7 x 1 cycle RT
28
stage IIA/B seminoma dose(s) and field
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
29
seminoma kidney constraints
single kidney D50 < 8Gy | bilateral kidney mean dose < 9Gy
30
criteria for bladder preservation
T2-T4a, no hydronephrosis, no extensive CIS, able to undergo maximal TURBT
31
Sedlis criteria for postop cervix
need two: LVSI size > 4cm stromal invasion > 2/3
32
Peters criteria for postop cervix
positive nodes, positive margins, parametrial invasion
33
components of radical hysterectomy
mobilization of ureters, bladder, and rectum , dissect parametria out to pelvic sidewall, remove upper half of vagina
34
postop cervix dose and fields
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
35
definitive cervix dose and fields
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.
36
definitive cervix whole pelvic fields
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
37
definitive cervix fields for positive PA nodes
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.
38
tandem and ovoid OAR constraints for bladder, rectum, and sigmoid (45Gy/25 EBRT + 30Gy/5fx HDR)
bladder: 90Gy EQD2, 6Gy per fx rectum: 75Gy EQD2, 5Gy per fx sigmoid: 75Gy EQD2, 5Gy per fx
39
inoperable endometrial cancer staging
``` 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 ```
40
describe tandem and ovoid procedure
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.
41
nasopharynx CTV structures
``` 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) ```
42
criticisms of Intergroup Al-Sarraf trial
``` non-endemic population older staging system pre-IMRT poor outcomes in RT-alone arm poor performance status poor protocol adherence ```
43
nasopharynx workup
MRI audiology, ophthalmology consults EBV titer (PCR)
44
nasopharynx DVH criteria
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
45
nasopharynx chemo
Cisplatin 100mg/m2 q3wk concurrent then adj cis 80 and CI 5FU 1000 x 3 cycles
46
nasopharynx 5yr OS
65-70%
47
general H&N workup
"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
T1N0 larynx simulation
"Supine with chin extended, no stent or shoulder pull, aquaplast mask, CT sim bolus over anterior if anterior commisure involement"
49
T1N0 larynx 2D field border
"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
T1N0 larynx surgical options
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
staging: T2 larynx
impaired cord mobility, tumor involves supraglottis or subglottis
52
staging: T3 larynx
vocal cord fixation, invading paraglottic space or inner cortex of thyroid cartilage
53
5yr OS for T1 and T2 larynx
T1 - 80% | T2 - 65%
54
advanced larynx target volumes
CTV70 - grass disease with 5mm margin CTV60 - entire larynx and involved nodal levels CTV54 - elective nodal levels (I-VI)
55
advanced larynx DVH
``` 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
endometrial - regimens for VBT only
6Gy x 5 to surface | 7Gy x 3 to 5mm depth
57
group stage for T3N0 breast
IIB (T2N1 or T3N0)
58
group stage for T2N2 breast
IIIA (T3N1 or T1-3N2)
59
group stage for T4N0 breast
IIIB (T4N0-2)
60
T2 pancreas
>2cm, confined to pancreas
61
N2 esophagus
3-6 nodes
62
group stage for T2N1 esophageal adeno
IIB (T3N0 or T1-2N1) 3 points
63
group stage for T1N2 esophageal adeno
IIIA (T1-2N2, T3N1, T4N0) 4 points
64
group stage for T3N2 esophagus
IIIB 5 points
65
N2 anal cancer
unilateral internal iliac nodes and/or unilateral inguinal nodes
66
group stage for T1-3N1 anal cancer
IIIA (T1-3N1, T4N0)
67
N2a vs N2b rectal cancer
N2a 4-6 nodes | N2b 7+ nodes
68
stage IIIA rectal cancer
T1-2N1 or T1N2a
69
N1 bladder
single lymph node in true pelvis
70
N2 bladder
multiple lymph nodes in true pelvis
71
N3 bladder
common iliac nodes
72
stage III bladder
T3N0 or T4aN0 (positive nodes are stage IV)
73
IB2 cervix
clinically visible lesion more than 4cm
74
IIA2 cervix
lesion >4cm involving upper vagina
75
IIB cervix
parametrial invasion
76
IIIA cervix
involves lower vagina
77
IIIB cervix
pelvic wall or hydronephrosis
78
II uterus
cervical stromal invasion
79
IIIA uterus
serosa or adnexa
80
IIIB uterus
vagina or parametrium
81
IIIC1 uterus
pelvic nodes
82
IIIC2 uterus
paraaortic nodes
83
IB vulva
>2cm in size or >1mm DOI
84
II vulva
distal urethra, distal vagina, anus
85
IIIA vulva
1-2 nodes < 5mm OR 1 node > 5mm
86
IIIC vulva
extracapsular extension
87
T4a larynx
invades through thyroid cartilage and/or invades soft tissues beyond larynx
88
T2 oropharynx
2-4cm
89
T4a oropharynx
larynx, deep tongue muscles, medial pterygoid, hard palate, mandible
90
group stage for T4aN2 H&N
IVA
91
group stage for T3N0 or T1-3N1 H&N
III
92
group stage for N3 H&N
IVB
93
T3 nasopharynx
invades bone or paranasal sinuses
94
T2 NSCLC
3-7cm, involving main bronchus >2cm from carina, visceral pleura, lobar atelectasis
95
T3 NSCLC
>7cm, parietal pleura, chest wall, diaphragm, phrenic nerve, main bronchus <2cm from carina, atelectasis of entire lung, separate tumors in same lobe
96
components of stage IIIA NSCLC
T1-3N2, T3N1, T4N0-1
97
components of stage IIIB NSCLC
any N3 or T4N2
98
Masaoka T2b
invasion of surrounding fatty tissue or mediastinal pleura
99
Masaoka T3a
invasion of neighboring organs excluding great vessels
100
Masaoka T3b
invasion of great vessels
101
lung 5 fraction SBRT dose constraints (cord, lung, everything else)
cord - 30Gy lung - V20 < 10% everything else - 105% of prescription dose
102
lung 3 fraction SBRT dose constraints (cord, lung, esophagus, heart, trachea/bronchus)
``` cord - 18Gy lung - V20 < 10% esophagus - 27Gy heart - 30Gy trachea/bronchus - 30Gy ```
103
NSCLC RTOG 0617 chemo regimen
RTOG 0617: weekly carbo AUC 2 and paclitaxel 45mg/m2, then adjuvant 2 cycles carbo AUC 6 and paclitaxel 200 mg/m2
104
advanced NSCLC DVH
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
NSCLC concurrent cis/etoposide doses
``` cisplatinum 50 (days 1, 8, 29, 36) etoposide 50 (days 1-5, 29-33) ```
106
LS-SCLC chemo doses
cis/etop 60/120 q4 weeks for 4 cycles
107
thymoma indications for adjuvant RT
R1-2 resection, stage III-IV
108
thymoma doses for R1, R2, and definitive
R1 - 54Gy R2 - 60Gy definitive - 70Gy
109
Deauville criteria
1. No uptake above background 2. Uptake ≤MS 3. Uptake >MS but ≤liver 4. Uptake moderately >liver 5. Uptake markedly >>liver 4 and 5 are always positive. In some situations, 3 is considered positive.
110
adjuvant pancreas classic fields
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
vulvar cancer indications for adjuvant RT
Heaps criteria - close margin (8mm), DOI > 5mm, LVSI Node positive

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