Palliative & Sarcomas Flashcards
Primaries for Bone mets
Breast and prostate
presenting symptoms for bone mets
Pain and impaired mobility
Two categories and how do they appear
Osteolytic: bone is eaten away (holes), decreased density, ragged margins, moth eaten
Osteoblastic: spots, not normal bone construction, results from new bone production spurred by bone destruction, increase density, isolated, round
Bone mets RT
Tx fields are typically visibly involved area +2cm margin
Dose: 800/1, 2000/5, 3000/10
pathological fracture higher with single fx
MC location for spinal cord mets
T spine
Clinical presentation for spinal cord mets
worsening back pain
Prognostic factor for spinal mets
ambulation
RT dose for spinal mets
3000/10 & 2000/5 (2500/10 for retreat)
Field size spinal mets
involved vertebrae +1 above and below
8-9cm wide in thorax and 9-10 in lumbar APPA
Cervical POP
Primaries for brain mets
Lung and breast
Diagnostic imaging for brain mets
Non-contrast CT initially
MRI (gadolinium)-contrast
PET scan and biopsy
MC location for brain mets
cerebral hemisphere
RT dose for brain mets
3000/10 2000/5
Prognostic indicators for brain mets
performance status
Standard brain fields and stepdown technique
supraorbital and mastoid tip
infraorbital and mastoid tip
Primaries for Esophageal obstruction skin mets hemoptysis hemorrhage visceral mets
esophagus melanoma lung bladder lung mets; breast liver mets: colorectal
what are the two most serious palliative emergencies?
esophagus obstruction: may lead to severe dysphagis, malnutrition, wt loss, dehydration
Hemoptysis: considered a medical emerg with 75% mortality rate. 1 cup of blood in 24 hrs.
Hemorrhage: loss of blood can result in low bp and dizziness
Treatment options for:
- esophageal obstruction
- Hemoptysis
- Nodal mets
- visceral mets
- stent, dilation
- goal is to stop bleeding and prevent aspiration
- Sx, RT chemo hormone therapy
- Chemo, hormones immunotherapy, Sx RT
Osteosarcoma dose
1-3cm of skin on one side of extremity must be spared
4-10MV 40-55Gy
Soft tissue sarcoma Dose
Factors to consider: age, disease extent, 3-8wks post-op
High grade post-op: 10cm margin on surgical scar 40-50Gy
Low grade: 5cm margin
1cm strip of skin
4-6MV, APPA, bolus
- S&S osteosarcoma
2. S&S Soft tissue sarcoma
- PAIN, mass or swelling
- often non specific, painless enlarging mass
Extremities (60%) MC location (Thigh)
Trunk
Epi/Eti and spread
- osteosarcoma
- soft tissue sarcoma
- rare, incidence between 10-30
Lungs, bone, liver - rare, usually remains confined to primary site
Lungs
Prognostic indicators and pathology
- osteosarcoma
- soft tissue sarcoma
- osteosarcoma and chondrosarcoma
how tumour responds to pre-op chemo and mets and present
2. There are over 50 types of sarcomas-based on tissues they arise from Children: Rhabdomyosarcoma Adults: Malignant fibrous histiocytoma leiomyosarcoma liposarcoma
