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1
Q

What are the SABR commissioning criteria

A

Confirmed histological diagnosis of metastatic carcinoma/sarcoma/melanoma
Disease free interval between primary treatment & manifestation of metastases of at least 6mths
1-3 sites of extra cranial, metastatic disease in 1-2 organs, including bone & spine, LN, liver, adrenal gland and/or lung
Maximum size of 5cm for any singe met
Life expectancy ≥6mths
PS ≤2

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2
Q

What tumours most commonly cause leptomeningeal disease

A

Breast, lung, melanoma

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3
Q

what factors should be considered when considering RT treatment of brain mets

A

Controlled or treatable extracranial disease
PS 0-1 (KPS ≥70)
Prognosis of at least 6mths

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4
Q

When should fractionated intracranial RT be considered over SRS
What dose is typically used for fractionated RT

A

Lesions larger 2-3cm, lesions close to a critical OAR or where V12Gy ≥10cm3 (the volume of normal tissue, excluding GTV, that receives at least 12Gy)

V12Gy of 5, 10 and >15cm3 = risk of radio necrosis of 10%, 15% and 20%

27Gy/3# or 30Gy/5#

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5
Q

What is the differential for small round blue cells seen on histology

A

ARSEPWMN
A - Acute leukaemia
R - rhabdomyosarcoma
S - Small cell lung cancer
E - Ewings sarcoma
P - PNET
W - Wilms tumour
M - Medulloblastoma
N - neuroblastoma

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6
Q

When is sentinel LN biopsy indicated for penile cancer

A

All except G1 T1

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7
Q

What defines a T1 penile cancer

A

T1 - sub epithelial connective tissue involvement

T1a - No LVSI and not poorly differentiated (G1-2)

T1b - LVSI or poorly differentiated (Gr 3-4)

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8
Q

What defines a T2 / T3 / T4 penile cancer

A

T2 - Invasion into corpus spongiosum +/- urethra
T3 - invasion into corpus cavernosum +/- urethra

T4 - invasion into other structures

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9
Q

How is nodal status categorised for penile cancer

A

N1 - unilateral inguinal nodal involvement

N2 - Multiple mobile or bilateral inguinal nodes

N3 - Fixed inguinal nodal mass or pelvic nodes

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10
Q

What tumours tend to be CK7- & CK20+

A

CK7-/CK20+ colorectal adenocarcinoma

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11
Q

What tumours tend to be CK7+ & CK20-

A

CK7+/CK20- “BBTSEX” = Breast, Bronchus (NSCLC), Thyroid, Salivary, Endometrial, Cervix

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12
Q

What tumours tend to be CK7- & CK20-

A

CK7-/CK20- HCC, RCC, prostate, SCLC & neuroendocrine tumours

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13
Q

What tumours tend to be CK7+ & CK20+

A

CK7+/CK20+ TCC bladder, pancreas, mucinous ovarian

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14
Q

How is immunotherapy induced colitis graded and managed

A

Gr1 - increase of ≤3 stools per day over baseline
Mx: continue ICI, symptomatic mx

Gr2 - increase of 4-6 stools per day over baseline
Mx: stop ICI, symptomatic mx & oral steroids

Gr3 - increase of >7 stools per day over baseline
Mx: stop ICI, symptomatic mx & IV MP, infliximab or vedolizumab if no improvement

Gr4 - life threatening
Mx: stop ICI and do not restart

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15
Q

How is immunotherapy induced hepatitis graded and managed

A

Gr1 - LFT up to 3x ULN
Mx: continue ICI, symptomatic mx & recheck bloods 1-2wkly

Gr2 - LFT 3-5x ULN
Mx: stop ICI, consider oral steroids

Gr3 - LFT up to 5-20x ULN
Mx: if ALT or AST <400 - oral steroids, if >400 - IV steroid.

Gr4 - LFT >20x ULN
Mx: IV MP

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16
Q

What tumours are typically CK20+ / CK7+

What other markers can be included

A

Bladder
Biliary

Urothelin - TCC
WT1 - primary ovarian cancers

17
Q

What tumours are typically CK20+ / CK7-

What other markers can be included

A

Colorectal
Mucinous ovarian
Merkel cell

CEA
CDX2

18
Q

What tumours are typically CK20- / CK7+

What other markers can be included and what do they indicate

A

NSCLC and mesothelium
Breast
Thyroid
Serous ovarian
Endometrial
Biliary

TTF1 (lung and thyroid)
ER/PR - breast
GCDFP - breast
GATA3 - breast
CK19 (cholangio & pancreatic)

19
Q

What tumours are typically CK20- / CK7-

What other markers can be included

A

SCLC
Squamous cell
Melanoma
liver
Prostate and renal
Cervix
Neuroendocrine

Hep-Par1 - HCC
PSA
CK5/6 - associated with squamous cell carcinoma and malignant mesothelioma
PAX8 - RCC & epithelial ovarian
S100 - melanoma

20
Q

What histology would PAX8 positivity suggest

A

Renal

21
Q

What is the dose conversion between doxorubicin and epirubicin re cardiac toxicity
And what is the 5% risk dose

What is the mechanism of cardiac toxicity

A

Doxo -> epi = 0.5
5% risk lifetime dose for doxorubicin - 450mg/m2
5% risk lifetime dose for epirubicin - 950mg/m2

Mechanism: dose dependent, oxidative stress and apoptotic loss of cardiomyocytes

22
Q

When does epirubicin dosing need to be altered

A

Hepatic dysfunction - liver eliminated

23
Q

What is the first line treatment of neuroendocrine tumours

A

If functioning - somatostatin analogue
2nd line:
if G1-2 - TKI sunitinib or everolimus
If G3 - chemotherapy

24
Q

What does CK5/6 indicate

A

Squamous carcinoma

25
Q

What does AE1/3 indicate

A

Positive = carcinoma
If no - melanoma, lymphoma, sarcoma

26
Q
A

FRCR2 (28 decks)

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