Lung onco and tech Flashcards
What is the aetiology?
Cigarette smoking,
- Asbestos ~ synergy with smoking
- Radon
- Metals; arsenic, beryllium, cadmium, chromium, haematite, nickel and tin mining
- Polycyclic aromatic hydrocarbons
- Ionizing radiation
What is the pathology?
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
What are the symptoms?
- 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
Treatment for early stage NSCLC?
- 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
What are the assesment for late stage NSCLC?
– Volume of disease – Lung function – Co-morbidities – Fitness for chemo – Symptoms
Fractionation NSCLC?
60Gy/30# (2G/f, 5 days a week for 6 weeks)
What are the palliative fractionations for NSCLC?
- 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#
Fractionation for SABR?
- Ablative doses of radiotherapy. BED >100Gy
- Usually in <5 fractions eg 54Gy in 3 fractions
Treatment for NSCLC?
- 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
Fractionation for NSCLC?
- 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)
What is PCI? And why is it used?
Prophylactic Cranial Irradiation (PCI)
• High incidence of cerebral metastases in SCLC
• Brain sanctuary site for chemotherapy, hence argument for use of PCI
Fractionation for PCI?
PCI Treatment
- Volume: Whole brain
- Technique: R and L lateral fields
- Dose: 25Gy in 10 fractions
How is respiratory motion overcome?
- Motion Encompassing; CT imaging that includes the entire range of motion, these include, Slow CT, Inhilation and exhalation breath hold CT, and 4DCT
• 4DCT: - Motion Compensation;
• Respiratory Gating: Imaging and delivery of XRT during a portion of the breathing cycle, the “gate - Motion Suppression: Breath hold methods
• Deep-inspiration breath-hold (DIBH);
• Active- Breathing control (ABC)
Side effects of Tx?
- 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