other

Question 1

What are the SABR commissioning criteria

Answer 1

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

Question 2

What tumours most commonly cause leptomeningeal disease

Answer 2

Breast, lung, melanoma
tx with whole brain RT

Question 3

How is immunotherapy induced colitis graded and managed

Answer 3

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

Question 4

How is immunotherapy induced hepatitis graded and managed

Answer 4

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

Question 5

When should ICI be stopped for suspected nephritis

Answer 5

Gr2 - If creat 1.5-3x ULN
start oral pred

Question 6

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

Answer 6

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

Question 7

What is the first line treatment of neuroendocrine tumours

Answer 7

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

Question 8

what tumours is acanthuses nigricans associated with

Answer 8

Gastrointestinal adenocarcinomas, (less commonly prostate, breast, and ovary. Other cancers, include lung, stomach, and lymphoma).

Question 9

what is important to add when using internal eye shields

Answer 9

Aseptic technique
local anaesthetic
Cannot drive
lubrication
patch after use