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Skin Radiation therapy > Palliative > Flashcards

Palliative Flashcards

1
Q

what percent of treatments are palliative ?

A

35-50%

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2
Q

goal of palliative treatmnt

A

relieve symptoms and maintain quality of life

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3
Q

dose for brain mets

A

20/5 or 30/10

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4
Q

what type of treatment plan is used for brain mets

A

linical markup (CMU): requires no simulation
Inferior border is set from a straight line from the supraorbital ridge to the tip of tragus or the lower junction of the ear
SOR to EAM → correct answer for CAMRT exam
This technique covers most of the brain and clears the lens

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5
Q

Borders for brain mets

A

Inferior: inferior to cribriform plate, cranial fossa and foramen magnum
Anterior: 3 cm posterior to the ipsilateral eyelid

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6
Q

inferior frontal lobe and temporal lobe brain mets

A

Portal must descend to infraorbital ridge and external auditory meatus
A lens or orbital block should be used

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7
Q

presentation of brain mets

A

eizures, headaches, focal and motor sensory deficits, gait disturbance, visual or speech changes, changes in memory, personality alterations, nausea and vomiting

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8
Q

medications that brain mets patients should get

A

for patients with seizures -dilantin is given

moderate dose and high dose corticosteroids (dexamethasone and prednisone) to help with ICP

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9
Q

how long does it take for corticosteroids to take effect

A

48 hours

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10
Q

diagnostic methods for brain mets

A

Contrast enhanced MRI → preferred imaging modality
CT and PET with FDG may also be used
If it is a first metastatic lesion, histologic confirmation should be obtained

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11
Q

are primary or metastatic brain tumours more common

A

metastatic is 10x more common than primary braintumours

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12
Q

what % of cancer patients develop brain mets during some point in their treatment

A

10-30%

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13
Q

most common primary its that lead to brain mets

A

lung, breast and melanoma

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14
Q

where do most brain mets occur?

A

Most brain metastases occur at the junction of the grey and white matter
80% of metastases are found in the cerebral hemispheres, 15% in the cerebellum and 5% in the brainstem

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15
Q

how do most tumours develop into brain mets

A

usually obtained through vasculature

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16
Q

what % of brain mets are single mets

A

40-50% are single mets

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17
Q

medial survival for someone diagnosed with brainmets

A

3 months

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18
Q

prognostic indicator most important in brain mets

A

karnofskys performance status is most important

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19
Q

treatment for solitary brain mets

A

sx followed by art dose of 30/10 patient status must also be good

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20
Q

treatment for bulky brain mets

A

whole brain radiation therapy +temolzomide, these patients are usually not candidate for SRS

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21
Q

Treatment for patients with 1-3 brain mets

A

WBRT (30/10)followed by SRS

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22
Q

Doses for patients for first treatment of brain mets and reirradiation of brain mets

A

brain mets can be treated with 30Gy initially then reradiated with 20Gy the second time brain mets often get reradiated

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23
Q

PCI and dose

A

PCI (Prophylactic cranial irradiation) is often given for patients with SCLC (small cell lung cancer) as there is a high propensity for brain mets DOSE: 25/10

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24
Q

SRS in brain mets

A

usually used for deep lesions and areas of serious neurologic deficit used for tumours that have progressed after WBRT

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25
Q

SYSTEMIC therapy in brain mets

A

temozolomide is an oral alkylating agent used in brain mets as there is a great CNS penetration

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26
Q

HBI for bone mets border

upper , mid and low body HBI

A

HBI (semi body radiation) is used for bone mets and has the borders below: Upper HBI: Covers thorax and abdomen, from the neck to the ischial tuberosities
Midbody HBI: Covers abdomen and pelvis from the diaphragm to the ischial tuberosities
Lower HBI: Top of the pelvis to the inferior portion of the femurs

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27
Q

is the dose higher or lower for upper body HBI vs lower body HBI? Why?

A

dose is lower for upper body HBI as we need to be aware of the dose limiting structures, the lung is a dose limiting structure in the upper body HBI remember its TD5/5 is 1750

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28
Q

doses in bone mets 8Gy/1fx vs 30Gy/10fx indications and pros and cons

A

8Gy/1fx is used for patients who prefer not to come back/ travel for treatments and are used for patients with poorer performance status and for patients with a shorter life expectancy CONS: of this treatment regime is that there is a 2-3 x high risk of needing pretreatment and there is a higher risk of flair up brain which can be treated by corticosteroids higher level of pathological fracture than longer treatment fractionations
30/10fx is used for patients with better prognosis, better life expectancy, performance status etc.

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29
Q

maximum tolerance dose for upper vs lower HBI

A

upper HBI MTD is 6Gy (due to the lung) and 8Gy for lower and mid HBI `

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30
Q

most common bone mets presentation

A

slowly progressive insidious pain that is usually worse at night

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31
Q

presentation of mets in the acetabulum

A

increase in pain in ambulation or weight bearing

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32
Q

presentation of mets in the ischium or sacrum

A

increase in pain when seated, less pain when ambulation

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33
Q

what imaging is the best for discovering bone mets

A

bone scans are most sensitive and specific Tc-99m is most important for screening individuals at risk for bone mets used to indicate osteoblastic (+ bone production) bone activity

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34
Q

what method is best at evaluation neoplastic invasion of bone marrow?

A

MRI is best at this and it can find invasion of red bone marrow and also is best at determining bone mets from osteoporosis

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35
Q

clinical examination for bone mets? what is done if the clinical exam indicated bone mets?

A

clinical exam requires HCP to palpate patients body and locate point tenderness which may indicate bone mets. if bone mets is thought then imaging is done

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36
Q

most common site of mets in general is to ____.

A

bone

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37
Q

what primary sites are most common in bone mets

A

breast and prostate comprise 70% of the primaries that cause bone mets

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38
Q

most common sites of bone mets

A

axial skeleton and lumbar spine

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39
Q

how long is the bone life cycle?

A

120-200 days

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40
Q

3 types of cells that make up bones

A

Osteocytes: Mature osteoblasts that maintain the bone’s structure
Osteoclasts: Originate from the bone marrow and adhere to the bone
Osteoblasts: Originate from the endosteum and periosteum and build bone by depositing collagen into the extracellular space

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41
Q

types of spread that lead to bone mets

A

most common is hematogenous followed by direct extension

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42
Q

primaries of breast and prostate cause bone mets in what part of the skeleton and why

A

in the axial skeleton because they have a high predilection to invade the red bone marrow Metastatic invasion of the bone cortex rarely happens without red marrow involvement → this is why the spine, pelvis and ribs are usually involved before the skull, femora, humeri, scapula and sternum

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43
Q

what 2 worse things can result from bone mets

A

pathologic fracture and spinal cord compression can result from bone mets

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44
Q

most common causes of pathologic fracture

A
  1. osteoporosis

2. bone mets

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45
Q

how long do people live after the diagnosis of bone mets

A

varies widely depending on the primary tumour
if lung is the primary- 6months
if breast or prostate is the primary- 2-4 months

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46
Q

pain relief to bones of different parts of the body

A

73% spine mets
88% limb mets
67% pelvic mets
75% mets in other parts of the skeleton

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47
Q

when is XRT used in bone mets when is cx used in bone mets

A

XRT is used for localized bone mets and Cx is used for diffuse bone mets

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48
Q

HBI for bone mets indications

A

Used for the palliation of symptoms and adjuvantly to prevent the formation of new bony metastases
Treats about ⅓ of the whole body and is divided into upper, middle and lower HBI
Used for pts with a short life expectancy with multiple symptomatic mets
used to palliate lytic bone mets (lytic = destroy bone think mottled bone) blastic lesion (extra bone is made)
Because of the potential for toxic effects to visceral structures and the difficulties in treatment setup, HBI is not routinely used to palliate multifocal bone mets

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49
Q

which occurs more quickly : the regeneration of peripheral blood counts or the regeneration of bone marrow

A

regeneration of peripheral blood counts occurs more quickly

the regeneration of bone marrow is influenced by pt age time after XRT, XRT volume and dose and sequencing of chemo

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50
Q

systemic XRT used in the treatment of bone mets

A

WFRT (Wide field radiation therapy) and radionuclide therapy

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51
Q

indications and contraindications for radionuclide therapy for bone mets

A

Suitable for pts with multiple bastic, painful mets who have exhausted all other EBRT
Contraindications: pts with poor renal or hepatic function, life expectancy < 6 weeks and urinary incontinence

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52
Q

where do most surgeries to treat bone mets occur

A

65% are for the femur

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53
Q

why is surgery used in bone mets

A

most surgery is to prevent OR TREAT pathologic bone fractures

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54
Q

what surgery is used for fractures of the femoral neck

A

total hip arthroplasty which replaces the femoral neck and the acetabulum or proximal femoral endoprosthesis alone

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55
Q

most common site of spinal cord compression

A

thoracic spine

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56
Q

prognostic factor most important for spinal cord compression?

A

patient ambulation

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57
Q

most common presentation of spinal cord compression

A

back pain that lasts for several weeks

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58
Q

diagnostic methods of spinal cord compression?

A

MRI and histologic confirmation should be given unless medically contraindicated

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59
Q

combined treatment modalities for SCC?

A

surgery followed by XRT

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60
Q

indications for surgery in SCC

A

Surgery should be especially considered for its with fracture, dislocation , paraplegia, radio resistant lesions, absence of steroid response or if there is no histologic confirmation of disease

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61
Q

different XRT plans for different areas of SCC

A

post field using 4-6MV photons
POP used for tumours approaching mid line
lats used for cervical SCC to spare the oropharynx

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62
Q

tumour dose is usually calculated at to cm for the cervicothoracic sine and at to cm for the lubrosacral spine for SCC

A

5-6cm for cervicothoracic spine

8-10cm for the lumbrosacral spine

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63
Q

Dose for SCC

A

30/10+18-30/6-15 = 40-45 Gy or 12-15Gy/3 +18-30/6-15 +40-45

no difference in outcomes between the fractionation schemes

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64
Q

the criteria indicating an impending bone fracture in bone mets

A
  1. lesions involving >50% of the diaphysis
  2. lesions destroying>50% of the cortex
  3. lesions >2.5 cm in the greater trochanter and the femoral neck region
  4. lytic lesions located in high stress areas
  5. involvement of the lesser trochanter, subtrochanteric or subcondylar areas
  6. Inadequate pain relief despite adequate EBRT being given
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65
Q

contraindications radionuclide therapy in bone mets

A

not used for patients with SCC, nerve root compression or patients with fractures, patients must also have adequate CBC, must have good renal and hepatic function have a life expectancy of more than 6 weeks and have urinary continence or else they ate not appropriate candidates

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66
Q

what medications can patients not take when they are getting radionuclide therapy for bone mets

A

patients can not have calcium containing medications when on radionuclide therapy because Ca competes with the radionuclide for uptake

67
Q

what radionuclide therapy can be given for bone mets

A

Sr89, Sm153, P32 is rarely used for bone pain relief due to excess myelosupression

68
Q

half life, tissue penetration and energy of radionuclides used in treating bone mets

A

Sr89- 1.46 Mev max, .58Mev average, 3-4mm penetration and 50.6 day half life
Sm153-.81Mev max, .29Mev average, 1.7mm penetration, 1.9 days half life

69
Q

types of visceral mets

A

visceral mets meaning mets of the internal organs include: Airway obstruction, superior vena cava obstruction, liver mets and gone bleeding

70
Q

treatment for airway obstruction

A

Keeping the bronchus with intraluminal brachy with 15-20Gy at 1 cm from the source OR EBRT with 2 8.5Gyfractions a week apart or 10Gy/1fx or 30Gy/10fx which palliates symptoms in 50% of cases

71
Q

primaries that cause superior vena cava obstruction

A

SCLC, NSCLC, lymphoma or germ cell tumours, NSCLC is less quick to respond to therapy than the other primaries

72
Q

is superior vena cava obstruction deadly?

A

no it is not usually deadly unless there is a complicating factor such as cerebral mets or tracheal obstruction

73
Q

how is superior vena cava obstruction diagnosed

A

by percutaneous FNA of the mass under CT or biopsy during flexible bronchoscope with a wang needle

74
Q

ear;y treatment for superior vena cava obstruction

A

elevating the head of the bed and diuretics and steroids

75
Q

XRT in superior vena cava obstruction

A

XRT is given when the patients condition is stable the patient will be in the supine position the mediastinum m is treated with 30Gy/3Gy/fx to 50Gy in 2.5Gy/fx

76
Q

median survival for patients with liver mets

A

4 months

77
Q

dose for EBRT of liver mets what kind of treatment delivery method is available

A

28-30Gy/ 2Gy/fx

SBRT can be given for liver mets

78
Q

what are treatment methods available for gene bleeding

A

Ferric subsulfate (morsel’s solution) can be sufficient to stop gone bleeding however this can cause vaginal sloughing or a urethral fistula therefore ensure you are applying the solution with the paste on a swab NOT gauze soaked
Palliative EBRT
Intracavitiary bratty can be given

79
Q

surgery for pathological fracture of the distal femur

A

managed by a plate and compression screw or with an intercondylar nail and screw

80
Q

preXRT medications given forgone mets

A

Pts are recommended to take anti-inflammatory and antiemetic medications prior to their radiation treatments to reduce acute side effects of HBI radiation
Medications are typically dexamethasone and ondansetron an hour before treatment

81
Q

radiopharmeceuticals are given for what kind of bone mets lesions?

A

mostly used for blastic bone mets (extra bone production)

82
Q

what do radoopharmaceuticals do for bone mets ?

A

Calcium and phosphorus analogs preferentially accumulate in bone
A beta emitter or low dose gamma source will allow for localized treatment where the radiopharmaceutical accumulates
Radiation is deposited directly at the involved area
This minimizes side effects and has an excellent therapeutic ratio
Is used in combination chemotherapy and radiation therapy

83
Q

types of primaries that lead to bone mets from most to least common

A

Breast
Lung
Prostate
Myeloma

84
Q

what primaries are more commonly osteoblastic bone mets and which are most commonly osteolytic bone mets?

A

bone mets with breast and lung primary are most often osteolytic myeloma is also purely osteolytic in nature
prostate primaries are most commonly osteoblastic
N.B. most of the mets have a combination of both osteolytic and osteoblastic features but they are classified by what feature is most prominent

85
Q

how often does pathologic fractures occurs in bone mets

A

in 8-30% of cases

86
Q

What bones/ parts of the bones are most likely to have pathological fractures?

A

proximal part of long bones are more likely to have bone mets than the distal parts of bones femoral neck and head are the most likely place for pathological fractures because of the propensity for mets and because they are weight bearing bones

87
Q

what causes esophageal obstruction

A

it could be due to late stage esophageal cancer or due to mets

88
Q

how is esophageal obstruction classified

A

it could be a mild obstruction up to a complete obstruction where the patient can not even swallow their own saliva

89
Q

treatment for esophageal obstruction (in general)

A

sx +xrt

90
Q

what is the treatment for a complete esophageal obstruction

A

a complete obstruction requires immediate surgery and is sometimes followed by XRT the surgery could have a stent placed to allow the patient to have food and beverages passed through

91
Q

bratty therapy for esophageal obstruction dose

A

Dose of 15 Gy at 1 cm or 18 Gy /3 fx or 16Gy/2 fx which all presented similar results

92
Q

when is brachytherapy used in esophageal obstruction

A

Brachytherapy may be useful following insertion of a stent , laser therapy or cryotherapy

93
Q

brachytherapy for esophageal obstruction instructions

A
  1. NG tube passed into stomach through area where tumor is
  2. X rays are taken to better localize the tumor and to help define the treatment length
  3. Dwell times are calculated, conventionally 1 cm from the source
  4. Treatment is delivered by inserting HDR catheter into afterloading machine
  5. Following treatment the NG tube can be removed and pt can be discharged
94
Q

hemoptosysis is usually from what primary cancer

A

hemoptysis is coughing up blood and is usually from a lung primary
can also be caused by XRT of the pulmonary artery or because of a small endobronchial lesion

95
Q

diagnostic methods in hemoptysis

A

Testing may be performed using chest x-ray and/or CT, endoscopy and lab testing

96
Q

different degrees of hemoptysis

A

minor and major hemoptysis

97
Q

surgeries used for major hemoptysis

A

Embolization via bronchial artery angiography
BUT emergency Sx may be used as a last resort
The goals are to prevent aspiration and exsanguination

98
Q

surgeries for minor hemoptysis

A

may be treated with surgical intervention (e.g. removal of tumour and anticoagulants may be used)

99
Q

treatment of hemoptysis as a result of endobronchial lesions

A

may be improved or relieved entirely with endoscopic laser fulguration in conjunction with EBRT, conventional low-dose brachytherapy or high-dose rate afterloading brachytherapy

100
Q

XRTdoses for hemoptysis

A

30-40Gy in 10-15fx

101
Q

primary sites that can cause hemorrhage

A

H&N and gone cancer also bladder and rectum cancer

102
Q

how often do advanced cancers have bleeding

A

in 6-10% of cases

103
Q

treatment for hemoptysis

A

Packing of gauze is typically performed to stop or slow the bleeding
Palliative doses are extremely effective at stopping bleeding
The mechanism by which XRT achieves hemostasis is unknown but is thought to affect tumour microvasculature and/or cause release of certain cellular products that improve blood clotting
Packing of gauze is typically performed to stop or slow the bleeding
Palliative doses are extremely effective at stopping bleeding
The mechanism by which XRT achieves hemostasis is unknown but is thought to affect tumour microvasculature and/or cause release of certain cellular products that improve blood clotting

104
Q

most common primary site that causes skin mets

A

breast cancer

other sites: melanoma and lung cancer

105
Q

is skin mets common or uncommon

A

is very rare compared to many other mets sites

106
Q

treatment skin mets

A

Treatment normally includes systemic therapy but local treatment may include Imiquimod cream, photodynamic therapy and excision
XRT is not commonly used as the condition is systemic

107
Q

how is nodal mets diagnosed

A

by PET or CT scan

108
Q

early stage nodal mets treatment

A

arly stage locoregional metastases are usually treated with XRT and/or Sx to tumouricidal doses
Microscopic nodal metastases are usually treated to 45Gy
Specific doses and techniques are discussed under each organ site

109
Q

late stage nodal mets treatment

A

Advanced stage nodal metastases are usually treated with palliative XRT doses and/or systemic therapy

110
Q

spinal cord compression definition

A

SCC develops when the spinal cord is compressed by a tumour or where the tumour has invaded one or more vertebrae and the spine collapses

111
Q

is SCC CONSIDERED an oncologic EMERGENCY

A

yes

112
Q

definition of an oncologic emergency

A

condition caused by cancer that can cause death or severe/permanent disability if not treated immediatelyNormally treated on the same day as they are Dx (usually within hours and at most 24hrs)

113
Q

Is SCC life threatening

A

it is an emergency but it is rarely life threatening

114
Q

most common technique used for treating SCC

A

4-6MV single post field most common
Opposed fields can be used if treatment volume approaches midline
Lateral fields can be used for cervical spine to spare oropharynx

115
Q

presentation for SCC

A 
Back pain 
These patients often exhibit bone pain
Paraparesis or paraplegia
Sensory loss
Bladder or bowel disturbances
116
Q

Diagnostic methods used in SCC

A

MRI → most informative study
If it is a first metastatic lesion, histologic confirmation should be obtained
Imaging such as CT would clearly demonstrate the SCC and the vertebra will look darker and may even be collapsed in extreme situations

117
Q

Most common site of SCC

A

70% thoracic spine
20% lubrosacral spine
10% cervical spine

118
Q

what primary tumours spread to what part of the spine in SCC

A

Lung and breast cancer metastasize to the thoracic spine

colon and pelvic tumours metastasize to the lumbrosacral spine

119
Q

how long is patient survival from diagnosis for SCC

A

7months

120
Q

most important prognostic factor for SCC

A

Patient ambulation patients who are ambulatory survive 8-9 months and non ambulatory patients survive 1 months

121
Q

combined modality treatment for SCC

A

Includes corticosteroids, XRT, neurosurgical interventions (laminectomy) or a combination laminectomy +XRT has a better outcome than either method alone

122
Q

tx of choice in SCC

A

xrt

123
Q

XRT indications in SCC

A

Usually used prophylactically but can also be used after it happens too
XRT can be used alone for patients who are ambulatory and XRT can be used for non ambulatory patients who respond to steroids

124
Q

most common treatment dose for patients with SCC

A

30/10

125
Q

Patient set up for patients T and L spine SCC

A

pts lie in the prone position, preferably, if not supine is okay too for direct spinal XRT

126
Q

Patient set up for patients with C spine SCC

A

usually treated with the patient in the supine position with lateral POP (never a direct PA)

127
Q

Borders for SCC treatment fields

A

~8 cm wide → 4 cm for width of vertebra +2cm margin on either side)
Length is calculated depending on the number of vertebrae to be treated → typically the physician will treat 1-2 vertebrae above and below the compressed spinal vertebrae
Each vertebra is ~2 cm in height
Superior and inferior borders are always placed at intervertebral spaces and never through vertebral bodies

128
Q

indications for surgery in SCC

A

Used for pts with acute-onset paraplegia, radioresistant lesions, absence of steroid response, no histologic proof of metastatic cancer
Laminectomy has been recommended for prompt reduction of tumour volume in an attempt to provide rapid relief

129
Q

Systemic treatment for scc

A

Dexamethasone usually provides pain relief and improves neurologic symptoms

130
Q

most common primary tumours that lead to paediatric SCC

A

Neuroblastoma, Ewings Sarcoma, Wilm’s Tumor, neuroblastoma being the most common primary tumor

131
Q

What causes paediatric SCC

A

Caused by neural foraminal invasion causing a “dumbell tumor”

132
Q

treatment for paediatric SCC

A

Chemotherapy can be used exclusively to allow for complete recovery
Emergency surgery can be used in cases with rapid neurologic progression at diagnosis
Radiation is reserved for pts who require palliation after disease progression after chemotherapy or surgery

133
Q

is SVCO an oncologic emergency

A

yes superior vena cava obstruction is an oncologic emergency

134
Q

signs and symptoms of superior vena cava obstruction ?

A

SOB, dyspnea, face/arm edema

Veins are swollen and those close to the skin may appear bulging across the chest, arms, head and neck

135
Q

primary cancer most commonly associated with SVCO

A

lung cancer

136
Q

how is SVCO diagnosed?

A

usually from FNA with CT guidance or transcranial biopsy with bronchoscopy

137
Q

patient care for SVCO patients

A

many of these patients require oxygen and a lot of significant physical support is needed

138
Q

patient position for treating SVCO with XRT

A

Many of these pts will be be able to lie prone for treatment, and some cannot maintain an orthopnea position and must be treated in a full upright position with gantry angles at 270 and 90 degrees for an AP/PA POP to the chest

139
Q

How long does it take for XRT to improve with SVCO

A

3 days after the start of XRT and 2 weeks for patients to achieve complete releif

140
Q

XRT dose for SVCO

A

Mediastinum is treated with doses ranging from 30-50 Gy in 3 Gy or 2.5 Gy fx, respectively

141
Q

Early treatment for SVCO

A

Early treatment: elevation of head and diuretics accompanied with steroids

142
Q

main primaries related to liver mets

A

Colorectal
Esophogeal
Stomach
Pancreatic

143
Q

presentation related to liver mets

A 
anorexia
Early Satiety
Weight loss
Nausea
Epigastric pain
Jaundice 
Fever
Most patients present with multiple metastatic deposits in the liver
144
Q

when is chemo agents used (adjuvant) neoadjuvant for liver mets

A

given neoadjuvantly to downsize the tumour in hopes of resecting it

145
Q

how is chemo administered for liver mets

A

arterial or hepatic infusions are better than oral agents

146
Q

chemo agents used for liver mets

A

Targeted agents such as cetuximab or bevacizumab are used

These combination of these agents have changed the goal of chemotherapy from palliation to prolonged survival

147
Q

SIRT for liver mets indications

A

selective internal radiation therapy Used for patients with diffuse liver mets

148
Q

SIRT for liver mets procedures

A

Uses Yttrirum 90 (a radioactive source) tiny microspheres are put down a tube into the hepatic vein straight to the liver

149
Q

dose pf EBRT for liver mets

A

Doses of 21 Gy/ 7fx or 30 Gy/ 15fx has proven to provide symptomatic relief

150
Q

median survival for liver mets

A

4 months

151
Q

indications for surgery for liver mets

A

Is best indicated with pts with clear resection margins, low levels of carcinoembryonic antigen, a single liver metastatic deposit, and node negative disease

152
Q

other treatments for solitary liver mets

A

Radiofrequency Ablation
Microwave coagulation therapy
Transarterial chemoembolization
Stereotactic body radiotherapy

153
Q

most common type of mets

A

bone mets

154
Q

bone mets are usually in one bone or multiple bones?

A

multiple bone

155
Q

As cancer cells damage the bones, calcium from the bones is released into the blood. This can lead to problems caused by high blood calcium levels, called

A

hypercalcemia

156
Q

what subtype of cancer causes bone mets?

A

adenocarcinoma (breast, prostate,lung thyroid, kidney

157
Q

most common location of bone mets

A

spine

158
Q

when do we treat bone mets with XRT

A

only we treat the bone mets if its symptomatic

159
Q

mechanism of pain relief with bone mets XRT

A

radiotherapy inhibits the normal cells release of chemical mediators of pain called prostaglandins and also prevents further bone destruction, reduces size of tumour and enables reabsorption of bone to take place

160
Q

How do biophosphonates work for bone mets?

A

inhibitors of bone resorption

effective in reducing morbidity in terms of pain, fractures ad hypercalcemia

161
Q

what radoopharmaceuticals used for bone mets

A

P32

SR89

162
Q

How do radoopharmaceuticals work for bone mets

A

follow the metabolic pathways of calcium in bone, as they decay they emits radiation

163
Q

most common primaries for brain mets

A

lung cancer, breast, melanoma, kidney, colon cancer

Skin Radiation therapy (40 decks)

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