Lung onco and tech Flashcards

1
Q

What is the aetiology?

A

Cigarette smoking,

  • Asbestos ~ synergy with smoking
  • Radon
  • Metals; arsenic, beryllium, cadmium, chromium, haematite, nickel and tin mining
  • Polycyclic aromatic hydrocarbons
  • Ionizing radiation
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2
Q

What is the pathology?

A

Majority of lung malignancies are bronchogenic (in the bronchial epithelium)

  • Out of the bronchogenic malignancies 80% are Non-small cell (NSC) while 20% are small cell
  • The NSC lung cancers are comprised of squamous cell carcinomas which make up 30% of lung cancer cases while adenocarcinomas make up 50% of lung cancer cases
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3
Q

What are the symptoms?

A
  • Primary lesion: Cough, Breathlessness, Haemoptysis, Chest pain
  • Intrathoracic Spread: pleural or pericardial effusion, hoarseness of voice, brachial plexus involvement, compression of SVC
  • Distant Metastasis: pain (bone mets); weakness and weight loss; headaches, seizures, neurological symptoms (cerebral mets)
  • Paraneoplastic: Set of symptoms due to the cancer but not caused by a systemic rather than local effect of cancer cells. Due to either immune response to the cancer or substances secreted by the cancer; SIADH, Hypercalcemia, Clubbing and hypertrophic pulmonary osteopathy
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4
Q

Treatment for early stage NSCLC?

A
  • Surgery +/ Adjuvant Chemo: Tumour must be resectable + acceptable lung & cardiac function + no other comorbidities that would preclude surgery
  • Radical Radiation Therapy (50Gy/20#, 60Gy/30#): If surgery is refused, or comorbidities that preclude surgery + acceptable lung function
  • Observe or Palliative RT: If poor lung function
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5
Q

What are the assesment for late stage NSCLC?

A
– Volume of disease 
– Lung function 
– Co-morbidities 
– Fitness for chemo 
– Symptoms
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6
Q

Fractionation NSCLC?

A

60Gy/30# (2G/f, 5 days a week for 6 weeks)

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7
Q

What are the palliative fractionations for NSCLC?

A
  • With chest symptoms and poor performance status; 16Gy/2# or 10Gy/1#
  • With chest symptoms and good performance status; 32Gy/12#
  • No symptoms and poor performance status; 16Gy/2# or 10Gy/1#
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8
Q

Fractionation for SABR?

A
  • Ablative doses of radiotherapy. BED >100Gy

- Usually in <5 fractions eg 54Gy in 3 fractions

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9
Q

Treatment for NSCLC?

A
  • Chemotherapy is the mainstay of treatment – 4 x cisplatin/etoposide
  • Thoracic RT – à increase local control – Two meta-analyses have demonstrated that the addition of thoracic RT to CT results in a small statistically significant improvement in survival
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10
Q

Fractionation for NSCLC?

A
  • Alternated fractionation schedule may be beneficial due to the rapidly growing nature of SCLC
  • Hyperfractionation; 45Gy/30# (1.5Gy p.d for 3 weeks), 45Gy/25# (1.8Gy 5 weeks)
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11
Q

What is PCI? And why is it used?

A

Prophylactic Cranial Irradiation (PCI)
• High incidence of cerebral metastases in SCLC
• Brain sanctuary site for chemotherapy, hence argument for use of PCI

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12
Q

Fractionation for PCI?

A

PCI Treatment

  • Volume: Whole brain
  • Technique: R and L lateral fields
  • Dose: 25Gy in 10 fractions
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13
Q

How is respiratory motion overcome?

A
  1. Motion Encompassing; CT imaging that includes the entire range of motion, these include, Slow CT, Inhilation and exhalation breath hold CT, and 4DCT
    • 4DCT:
  2. Motion Compensation;
    • Respiratory Gating: Imaging and delivery of XRT during a portion of the breathing cycle, the “gate
  3. Motion Suppression: Breath hold methods
    • Deep-inspiration breath-hold (DIBH);
    • Active- Breathing control (ABC)
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14
Q

Side effects of Tx?

A
  • Cough; - avoid dry air and smoking
    • use extra pillows
    • rest between activities
  • Dyspnoea- shortness of breath; - avoid triggers eg. Wind, pollen, smoke
    - use relaxation techniques
    - physio help
  • Pneumonitis- inflamed lung tissue; - late effect- up to 3-6 months following XRT
    - medical treatment necessary
  • Oesophagitis- heartburn; - small meals
    - soft, bland foods
    - avoid temperature extremes
    - avoid alcohol and coffee
    - meds: viscous xylocaine etc.
  • Skin reaction; - mild soap
    - no talc or deodorant on tx area
    - avoid very hot/cold water
    - no shaving, perfume on tx area
    - apply appropriate moisturiser 3x day

Fatigue; - frequent rests
- gentle exercise

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