metho 3 Flashcards
1
Q
What are the main regions of the head and neck anatomy?
A
Nasopharynx, oropharynx, hypopharynx, larynx, oral cavity, salivary glands, thyroid
These regions are important for understanding the anatomy relevant to head and neck cancers.
2
Q
What are the critical structures in head and neck radiation therapy?
A
OARs: Brainstem, spinal cord, optic nerves, eyes, parotid glands, mandible
OAR stands for Organs at Risk.
3
Q
which cancers do not have lymphatic drainage
A
larynx paranasal sinus
4
Q
What are the levels of lymph nodes in the head and neck?
A
- Level 1: Submental and Submandibular
- Level 2: Upper Jugular
- Level 3: Middle Jugular
- Level 4: Lower Jugular
- Level 5: Posterior Triangle
- Level 6: Anterior Compartment
5
Q
How many Canadians are diagnosed with head and neck cancer each year?
A
8,100
6
Q
What is the most common histology of head and neck cancer?
A
Squamous cell carcinoma, accounting for about 90% of cases
7
Q
What are some risk factors for head and neck cancer?
A
- Tobacco use
- Alcohol abuse
- HPV
- EBV
8
Q
List common signs and symptoms of head and neck cancer
A
- Lump or swelling in neck, mouth, or throat
- Persistent sore throat
- Difficulty and pain on swallowing
- Hoarseness or voice change
- Unexplained weight loss
- Ear pain or hearing loss
- Nasal obstructions or congestion
- Bleeding
- Numbness
- Non-healing sores
9
Q
What is the gold standard for diagnosing head and neck cancer?
A
Biopsy
10
Q
What are the treatment principles for head and neck cancer?
A
- Tumor eradication
- Functional preservation
- Multidisciplinary approach
Each treatment plan is tailored based on tumor characteristics and patient needs.
11
Q
Where are the location of BBs on head and neck
A
laterals: midneck, approximately EAM
nasopharynx and paranasal sinus: anterior midline on chin
oro / hypo : anterior midline above larynx
cervical eso: anterior low on neck
thryoid: anterior below larynx
12
Q
what is the image matching for head and neck cancers
A
bony anatomy match
13
Q
What are common side effects of radiation therapy for head and neck cancer?
A
- Mucositis
- Xerostomia (dry mouth)
- Dysphagia (difficulty swallowing)
- Skin reaction
Management strategies vary for each side effect.
14
Q
What is the typical dose range for curative intent radiation therapy for primary tumors?
A
66–70 Gy, delivered in fractions of 2 Gy per session over 6–7 weeks
Postoperative high-risk areas may receive 60–66 Gy.
15
Q
What is the purpose of palliative care in head and neck cancer treatment?
A
Management of advanced or recurrent disease, focusing on symptom control and quality of life
This includes pain management and alleviating swallowing difficulties.
16
Q
What is the purpose of the Aquaplast procedure in radiation therapy?
A
To create a thermoplastic mask for patient immobilization during treatment
Proper molding ensures accurate treatment delivery.
17
Q
What are the critical dose constraints for optic structures during radiation therapy?
A
- Eyeball: 40 Gy
- Retina: 45 Gy
- Lens: 5-10 Gy
- Optic nerve: 54 Gy
- Optic chiasm: 54 Gy
- Lacrimal gland: 30 Gy
These constraints help minimize radiation damage to sensitive structures.
18
Q
what are the conventional head and neck doses for T1,T2,T3-4 Lesions
A
T1: 6000 - 6500
T2: 6500 - 7000
T3-T4: 7000 - 7500
19
Q
What is the Homolateral Wedge Pair Technique used for?
A
Intended for tumors laterally located without midline crossing and no risk of contralateral nodal spread
This technique aims to optimize dose distribution.
20
Q
What is the Bull’s Eye Technique mainly used for?
A
Maxillary antrum and para-nasal sinuses, also used for nasopharynx
This technique allows for targeted radiation delivery.
21
Q
What is the site that uses of the Bull’s Eye Technique?
A
Maxillary antrum and para-nasal sinuses
Also used for nasopharynx.
22
Q
What are the boundaries of the Anterior Field in the Eye Technique?
A
Superior: above frontal sinus
Inferior: through odontoid process
Medial: contralateral eye inner canthus
Lateral: beyond skin for sinuses or antrum
23
Q
What areas are boarders of the lateral Field of the Eye Technique?
A
Superior: above frontal sinus
Posterior: EAM
Anterior: posterior bony orbital ridge
Inferior: below hard palate
24
Q
What is the Lateral POP Technique?
A
Small field with right and left lateral field, usually half arcs
Targets sites like glottis, cartilages, para glottic spaces, and anterior commissure.
25
What is the purpose of the Angle Down Pair? What does it target
To target the larynx, hypopharynx, and proximal 1/3 esophagus
26
What are the dose recommendations angle down pair technique Larynx treatment?
6000cGy / #30 to primary
2000cGy / #10 to boost (+)LN
1000cGy / #5 to (-) LN
27
What is the technique used for Conventional Head and Neck treatment?
Multiphase Single Isocentre 3 Field Technique (Lateral POP and Anterior Split Supraclavicular Field)
28
What does Phase 1 of Conventional Head and Neck treatment involve?
Large H+N and Anterior Split fields with specific photon doses for lateral POP and anterior split
29
What is the dose for Lateral POP Photon Boost?
1400cGy to a total of 6000cGy to regional LN and Tumour
30
What is the purpose of IMRT?
Increased conformality of Treatment with different doses at the same time
31
What is the typical PTV definition in IMRT?
PTV = CTV + 3cm – 5cm Margin
32
What is VMAT and its main advantage?
Main option for Head and Neck Radiation with shorter delivery time than IMRT (~5 mins)
33
What is the goal of Adaptive Radiation Therapy?
To adjust treatment plans in real time due to changes in tumor size or patient weight
34
What is the workflow for IGRT using CBCT?
Prepare Clip-box, Setup Patient, Acquire CBCT, Image Registration, Review Image Registration, Treat
35
What are the general management principles for treating head and neck cancers?
Surgery for small lesions, XRT for inaccessible lesions, use of adjuvant XRT for local control
36
What is the preferred treatment for paranasal sinuses?
Usually managed by surgery with postoperative radiation for T4/T4 or positive margins
37
Why is radiation preferred over surgery for nasal cavity cancers?
Due to cosmesis, especially for rare and late-diagnosed cancers
38
What is the main treatment for nasopharynx cancers?
Radiation is the main treatment with adjuvant lymph node radiation
39
What is the goal in treating hypopharynx cancers?
Local control and preservation of swallowing function
40
What is the typical radiation dose for the mantle technique?
35-44 Gy to the involved areas
41
What does the Inverted Y Technique target?
Infra-diaphragmatic lymph nodes, including para aortic, iliac, and femoral LNs
42
What are the four main classical approaches of irradiating lymphomas?
* Involved Field (IF)
* Extended Field (EF)
* Total Lymphoid Irradiation (TLI)
* Subtotal Lymphoid Irradiation (STLI)
43
What is the difference between Hodgkin’s and Non-Hodgkin’s Lymphoma in terms of radiation therapy?
Hodgkin’s Lymphoma often uses radiation as a cornerstone treatment, while Non-Hodgkin’s Lymphoma relies more on chemotherapy and immunotherapy.
44
What is the typical dose for the inverted Y field that treats both paraaortic and pelvic nodes?
35-44 Gy
## Footnote
The inverted Y technique is often used for advanced stage Hodgkin's Lymphoma with extensive lymph node involvement.
45
What is the superior border for the pelvic fields technique?
L4/L5
## Footnote
This is relevant for planning radiation therapy for pelvic lymph nodes.
46
What lymph nodes are included in the target volume for pelvic fields technique?
Iliac and inguinal lymph nodes
## Footnote
The dose may be adjusted based on the extent of disease.
47
What is the typical radiation dose to the pelvis?
35-44 Gy
## Footnote
This dose is used when there is involvement of the inguinal or pelvic lymph nodes.
48
What is the purpose of the pre-auricular field?
To treat clinical involvement of the preauricular lymph nodes or upper cervical lymph nodes
## Footnote
This technique uses ~9 MeV electrons.
49
What types of thyroid cancer are most common?
* Papillary Thyroid Cancer (80%)
* Follicular Thyroid Cancer (10-15%)
* Medullary Thyroid Cancer (3-5%)
* Anaplastic Thyroid Cancer (2%)
## Footnote
These percentages reflect the distribution of thyroid cancer types.
50
What is the typical treatment regimen for Hodgkin's Lymphoma?
ABVD Regimen
## Footnote
This includes Adriamycin, Bleomycin, Vinblastine, and Dacarbazine.
51
What are the stages of Non-Hodgkin's Lymphoma?
* Stage I: One lymph node region or a single organ
* Stage II: Two or more LN regions, single organ with associated LN on the same side of the diaphragm
* Stage III: LN on both sides of the diaphragm
* Stage IV: Widespread involvement of organs, bone marrow involvement
## Footnote
These stages help in determining the treatment approach.
52
What is the typical radiation dose range for localized early-stage Non-Hodgkin's Lymphoma?
30 to 40 Gy
## Footnote
This is usually delivered in fractions over 2 to 4 weeks.
53
What is the role of the pituitary gland in the endocrine system?
It regulates critical functions via hormones affecting growth, metabolism, reproduction, and water balance
## Footnote
The pituitary communicates with the hypothalamus, influencing other endocrine organs.
54
What are common symptoms of thyroid cancer?
* A noticeable lump or nodule in the neck
* Difficulty swallowing or breathing
* Hoarseness or voice changes
* Pain in the neck or throat
* Enlarged lymph nodes in the neck
## Footnote
These symptoms may vary based on the type of thyroid cancer.
55
What is the typical radiation dose for pituitary cancer treatment?
45 to 54 Gy
## Footnote
This is delivered in daily fractions over a period of 4 to 6 weeks.
56
What technique is often used for treating advanced stage Hodgkin’s Lymphoma?
Involved Node Radiotherapy (INRT)
## Footnote
This evolved from previously used terms like Involved Field Radiotherapy (IFRT).
57
What is the primary treatment option for differentiated thyroid cancers?
Radioactive Iodine (RAI) Therapy
## Footnote
Iodine-131 is the radioactive isotope used in this therapy.
58
What is the definition of the thyroid-pituitary axis?
The hypothalamus releases TRH, stimulating the pituitary to release TSH, which in turn stimulates the thyroid to produce T3 and T4
## Footnote
This creates a negative feedback loop regulating hormone levels.
59
What are the indications for radiation therapy in pituitary cancer?
* Incomplete resection of invasive tumor
* Tumors with suprasellar extension
* Large tumors where surgery risks are high
* Persistent hormonal elevation after surgery
## Footnote
These factors guide the decision for radiation therapy.
60
What is the treatment goal for patients with pituitary tumors?
Normalize pituitary hormonal function and relieve local compression
## Footnote
Preventing recurrence is also a critical treatment goal.
61
What is the standard radiation therapy dose for pituitary treatment?
Typically ranges from 45 to 54 Gy delivered in daily fractions of about 1.8 to 2 Gy over 4 to 6 weeks.
62
What are the standard stereotactic radiation doses?
Ranges from 12 to 18 Gy in a single fraction or 25 to 30 Gy delivered in 3-5 fractions.
63
What percentage of all cancers do malignant adrenal gland tumors account for?
0.04 %.
64
What hormones do the adrenal cortex and medulla produce?
* Cortex: steroid hormones for metabolic regulation
* Medulla: epinephrine (adrenaline)
65
What are common patterns of spread for adrenal gland cancer?
* Local growth into surrounding tissues
* Spread to regional para-aortic lymph nodes
* Distant metastasis to lung, liver, or brain
66
What is the treatment of choice for adrenal gland cancer?
Surgery.
67
What role does radiation therapy play in the management of CNS tumors?
* Curative Intent (Definitive Radiation Therapy)
* Adjuvant Therapy (Post-Surgical Radiation)
* Palliative Therapy (Symptom Management)
* Prophylactic Cranial Irradiation
68
What percentage of malignancies do brain tumors account for?
1.4%.
69
What are the two peaks in the incidence of CNS tumors?
Young and old.
70
What is the most common classification of brain tumors?
Gliomas, accounting for 30% and 80% of all malignant brain tumors in this classification.
71
What factors determine the prognosis of CNS tumors?
* Age
* Performance Status (Karnofsky)
* Tumor Type / Grade
72
What does the Karnofsky Performance Status assess?
Patients' ability to perform everyday tasks.
73
What is the significance of the ECOG Performance Status?
It monitors functional status.
74
What are the two regions of the brain anatomy?
* Supratentorial Region
* Infratentorial Region
75
What is the primary pattern of spread for gliomas?
Local invasion and CSF seeding.
76
What initial symptom may indicate a brain tumor?
Headache, usually worse in the morning.
77
What are common side effects of CNS radiation therapy?
* Fatigue
* Headaches
* Nausea
* Skin irritation
* Hair loss
* Swelling in the brain
78
What are the brain organs at risk during radiation?
* Optic Chiasm (54 Gy)
* Cochlea (45 Gy)
* Hippocampus (12-20 Gy)
* Brainstem (54 Gy)
* Pituitary Gland (50-60 Gy)
* Retina (45-50 Gy)
* Lacrimal Gland (40 Gy)
* Lens (1 Gy)
79
What is the purpose of CT simulation in radiation therapy?
To acquire detailed cross-sectional images of the brain for treatment planning.
80
What is Whole Brain Irradiation (WBI) used for?
* Treat multiple brain metastases
* Alleviate symptoms in palliative care
* Prevent brain metastases in high-risk patients
81
What is a common acute side effect of CNS radiation?
Fatigue.
82
What management strategies are recommended for taste changes due to radiation?
Advise a variety of foods to find tolerable flavors.
83
What is Osteoradionecrosis (ORN)?
Damage to the jawbone due to reduced vascularity and tissue healing capacity.
84
What are the common symptoms of Osteoradionecrosis?
* Jaw pain
* Exposed bone
* Risk of infection
85
What is the role of radiation in cranial spinal irradiation?
To treat brain and spine simultaneously, mainly for medulloblastoma and ependymoma.
86
What does the ICRU Guidelines define in radiation therapy?
* Gross Target Volume (GTV)
* Clinical Target Volume (CTV)
* Planning Target Volume (PTV)
87
What is the expected management for skin irritation caused by CNS radiation?
* Topical treatments (e.g., aloe vera, corticosteroid creams)
* Gentle skin care practices
88
What advanced techniques aim to minimize side effects of CNS radiation?
Techniques that spare healthy brain tissue.
89
how many of body lymphnodes are in the head
1/3
90
other than squamous cell, what are other common histologies
nasopharyngeal carcinoma and mucosal carcinomas
91
What are the forms of diagnostic work up
Medical history and examination
Endoscopy
Biopsy
Imaging - CT / MRI / PET / X-ray
92
93
What are the scanning parameters for standard head and neck
Above frontal sinus to carina
94
What are the scanning parameters for nasopharyngeal and paranasal sinus
Apex to head of carina
95
What are the scanning parameters of hypopharyngeal cancer (and also cervical esophagus)
Above frontal sinus to 2-3 cm below diaphragm
96
What are the scanning parameters for thyroid cancer
Lower orbital ridge to include entire lung
97
What is the typical dose for CURATIVE intent in the PRIMARY tumour in HIGH risk areas
66-60 Gy, delivered in 2 Gy per session over 6-7 weeks
98
What is the dose / fractionation for postoperative tumours and HIGH risk areas
60-66Gy
99
What is the dose and fractionation of elective lymphnode irradiation (lower risk areas)
50-54 Gy in 1.8-2Gy fractions
100
What is the dose and fractionation of palliative head and neck cancers
30-50 Gy , with hypofractionated regimens 30Gy in 10 fractions
101
What is mucositis
Inflammation and ulceration of mucosal lining in the oral cavity
102
How do you manage mucositis
Saline or baking soda mouth rinses , topical anaesthetics (lidocaine) , pain control (analgesics)
103
What is xerstomia (dry mouth), when does it occur, what are the symptoms, and how do you manage it
- swelling and inflammation of the pharynx and esophagus
- worsens as treatment progresses
- modified diet, nutritional support, and swallowing therapy exercises
104
What is dysgeusia , how is it managed, when is the onset, what are the symptoms
- taste changes
- altered or reduced sense of taste due to damage to taste buds and salivary glands
- within the first few weeks of treatment
- metallic, bitter, or complete loss of taste
- diet management
105
The
106
107
What sites may use homolateral wedge pair technique
Parotid gland
Submanibular salivary glands
Middle ear
Orbit
Oral cavity
Oropharynx
108
What is direct, mixed beam technique
Combination of photon and electron field , photon field on one lateral
109
What are the boarders of the direct, mixed beam technique
Superior : inferior orbital margin or up to base of skull depending on histopathology
Anterior: 2nd upper molar
Posterior: posterior to mastoid process
Inferior: below mandible, dependant on disease
110
What are the doses for direct, mixed beam technique
5000 - 7000 cGy , in daily doses of 200 cGy
111
What are the boarders for the anterior field for bulls eye technique
Superior: above frontal sinus
Inferior: through odontoid process
Medial: contra lateral inner canthus
Lateral: beyond skin for sinuses or antrum
\
112
What are the boarders for the lateral field for bulls eye technique
Superior : above frontal sinus
Posterior: EAM
Anterior: posterior bony orbital ridge
Inferior: below hard palate
113
114
115
What are the boarders of the angle down technique
Superior: Jugulodiagastric nodes
Inferior: SSN
Anterior: clear skin by 1 cm
Posterior: variable
