Palliative & Sarcomas

Question 1

Primaries for Bone mets

Answer 1

Breast and prostate

Question 2

presenting symptoms for bone mets

Answer 2

Pain and impaired mobility

Question 3

Two categories and how do they appear

Answer 3

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

Question 4

Bone mets RT

Answer 4

Tx fields are typically visibly involved area +2cm margin
Dose: 800/1, 2000/5, 3000/10
pathological fracture higher with single fx

Question 5

MC location for spinal cord mets

Answer 5

T spine

Question 6

Clinical presentation for spinal cord mets

Answer 6

worsening back pain

Question 7

Prognostic factor for spinal mets

Answer 7

ambulation

Question 8

RT dose for spinal mets

Answer 8

3000/10 & 2000/5 (2500/10 for retreat)

Question 9

Field size spinal mets

Answer 9

involved vertebrae +1 above and below
8-9cm wide in thorax and 9-10 in lumbar APPA
Cervical POP

Question 10

Primaries for brain mets

Answer 10

Lung and breast

Question 11

Diagnostic imaging for brain mets

Answer 11

Non-contrast CT initially
MRI (gadolinium)-contrast
PET scan and biopsy

Question 12

MC location for brain mets

Answer 12

cerebral hemisphere

Question 13

RT dose for brain mets

Answer 13

3000/10 2000/5

Question 14

Prognostic indicators for brain mets

Answer 14

performance status

Question 15

Standard brain fields and stepdown technique

Answer 15

supraorbital and mastoid tip

infraorbital and mastoid tip

Question 16

Primaries for
Esophageal obstruction
skin mets
hemoptysis
hemorrhage
visceral mets

Answer 16

esophagus
melanoma
lung
bladder
lung mets; breast liver mets: colorectal

Question 17

what are the two most serious palliative emergencies?

Answer 17

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

Question 18

Treatment options for:

1. esophageal obstruction
2. Hemoptysis
3. Nodal mets
4. visceral mets

Answer 18

1. stent, dilation
2. goal is to stop bleeding and prevent aspiration
3. Sx, RT chemo hormone therapy
4. Chemo, hormones immunotherapy, Sx RT

Question 19

Osteosarcoma dose

Answer 19

1-3cm of skin on one side of extremity must be spared

4-10MV 40-55Gy

Question 20

Soft tissue sarcoma Dose

Answer 20

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

Question 21

1. S&S osteosarcoma

2. S&S Soft tissue sarcoma

Answer 21

1. PAIN, mass or swelling
2. often non specific, painless enlarging mass
   Extremities (60%) MC location (Thigh)
   Trunk

Question 22

Epi/Eti and spread

1. osteosarcoma
2. soft tissue sarcoma

Answer 22

1. rare, incidence between 10-30
   Lungs, bone, liver
2. rare, usually remains confined to primary site
   Lungs

Question 23

Prognostic indicators and pathology

1. osteosarcoma
2. soft tissue sarcoma

Answer 23

1. 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