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ONCOLOGY & CC > Radiation Oncology > Flashcards

Radiation Oncology Flashcards

1
Q

high energy radiation that is given off from radioactive materials

sufficient energy to eject an electron

A

Ionizing Radiation

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2
Q

Low-energy radiation like radio wave and microwaves

A

Non-ionizing radiation

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3
Q

the amount of radiation absorbed by a person’s body

A

radiation dose

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4
Q

Example of internal radiation contamination through inhalation of radiation exposure

A

radon

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5
Q

Radiation can be ______ or ______

A

particles or waves

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6
Q

What are the biological effects of radiation

A

damages mammalian cells by deposition of ionizing radiation at or near DNA
-random and discerete

33% of time radiation hits DNA leading to direct damage (single or double strand breaks)
67% of time radiation creates ROS leading to indirect damage

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7
Q

Radiation causes mostly what type of cell death

A

Mitotic Cell Death - DNA damage breaks and leading to abnormal chromosome set that is unable to be pulled apart

but some tissues under go apoptotic death

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8
Q

What tissues have significant apoptotic death

A

some normal tissues (lymphocytes, salivary glands, lacrimal glands) and some tumor types (lymphoma) have significant apoptotic death
-Round cell tumors? like mast cells and thymoma but 50-50

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9
Q

hypofractionated

A

<10 doses

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10
Q

fractionated

A

10+ doses

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11
Q

high dose per fraction radiation therapy delivered over a short (<5fractions) period of time
Requires a CT scan

A

Sterotactic (body) radiation therapy

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12
Q

conformal radiation therapy based on CT scan

A

intensity modulated radiation therapy (IMRT)

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13
Q

piece on the linear accelerator where the radiation comes from

A

gantry

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14
Q

piece on the linear accelerator that helps to scope dose to area being treated

A

multi-leaf collimator/beam

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15
Q

most common primary bone tumor in dog
occurring near the metaphysis of the bone

A

Osteosarcoma

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16
Q

Where does osteosarcoma typically occur

A

-Proximal humerus
-Distal Radius
-Distal Femur
-Distal tibia
-Proximal tibia

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17
Q

What are considerations for using stereotactic body radiation for OSA patients

A

1) Integrity of the bone on CT (4 characteristics to look for fracture risk)

2) Degree of lameness on physical examination

3) Skin -if open wound, wont heal

4) Size of the lesion- worse if larger lesions

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18
Q

What is the biggest risk when doing stereotactic body radiation therapy for OSA

A

Fracture
Skin changes

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19
Q

What is stereotactic body radiation

A

-Implies hypofractionation
(1-5 treatment)
-High dose/fraction
-Semi-rigid immobilization
-Target localization (contouring and on-bard imaging)
-Spares normal tissues by avoidance

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20
Q

How does stereotactic body radiation therapy spare normal tissues

A

avoidance

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21
Q

What are the qualifications of sterotactic body radiation therapy (SBRT)

A

1) Gross disease - dont cut out target
2) Intact healthy skin
3) Ct for planning

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21
Q

What disqualifies a cancer from being able to use Stereotactic body radiation therapy on?

A

1) Pathologic fracture
2) Oronasal fistula
3) Inability to adequately avoid normal tissues

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22
Q

What are the goals of stereotactic body radiation therapy

A

-Curative
-Durable palliation

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23
Q

a sterotactic body radiation type that uses Cobalt 201 sources
rigid framework for immobilization
driven by neurosurgeons to deliver a single large dose of radiation to inoperable lesion

A

Gamma Knife

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24
Q

tumor perfusion deficits following SBRT lead to

A

acute hypoxia and changes in DNA repair mechanisms

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25
Q

What is needed for SBRT

A

1) CT scan
2) Immobilization
3) Target localization

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26
Q

Palliative radiation therapy is

A

short, less intense protocol
-Reduced side effects
-Very simple set up- radiograph and some physics math

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27
Q

What is the goal of palliative radiation

A

improve quality of life and decrease pain
but not necessarily extend the quantity of life

-improve function
-improve hygiene
-unobstruct urethra/ureter
-stop bleeding

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28
Q

What are the proposed mechanisms on how radiation might improve pain

A

-Radiation effect on pain mediators and inflammatory cytokines
-Disruption of neuronal transmission of pain
-Radiation associated inhibition of osteoclast activity and resulting bone absorption

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29
Q

How do you diagnose Urogenital carcinoma

A

Cytology
Histopathology
BRAF test: ~95% of TCC/UC cases

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30
Q

What is the biggest challenges with making a radiation plan for urogenital carcinoma

A

it frequently changes in size with the bladder

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31
Q

non-uniform dose delivery
-modulated dose output
can be fractionated or hypofractionated

A

Intensity modulated radiation therapy (IMRT)

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32
Q

What are the advantages of Intensity modulated radiation therapy (IMRT)

A

Treat complex tumor shapes
minimize dose to normal tissues

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33
Q

What does Intensity modulated radiation therapy (IMRT) require

A

on-boarding imaging (OBI)
-MV portal films
-Kv-KV images
-KV-CBCT

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34
Q

How many fractions is Intensity modulated radiation therapy (IMRT) typically in vet med?

A

1-20 fractions

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35
Q

What are the risk factors when a patient is being treated with radiation

A

1) Total radiation dose
2) Dose per fraction
3) Number of fractions
4) Energy of beam
5) Treatment time
6) Field Size
7) Previous treatments
8) Concurrent medications

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36
Q

What are types on non-malignant conditions that can be treated with radiation therapy

A

1) Sialocele
2) Osteoarthritis
3) Meningoencephalitis of unknown origin
4) Pulmonic stenosis
5) Feline idiopathic cystitis (single low dose)

37
Q

What medication is a risk factor to the gastrointestinal tract for patients receiving radiation

A

Toceranib phosphate (Palladia)

38
Q

What medication is a risk factor to the heart for patients receiving radiation

A

Doxorubicin

39
Q

What are the skin specific risk factors for patients receiving radiation therapt

A

1) Presence of skin folds in the field
2) Individual variation
3) Use of Bolus
4) Kilovoltage radiatio
5) Electrons
6) Infection
7) Wound/Ulcerations

40
Q

What are heart specific risk factors for patients receiving radiation therapy

A

1) Doxorubicin tx
2) Valvular stenosis
3) Arrhythmias

41
Q

Does KD or MD radiation accumulate more in bone

A

KD

42
Q

acute radiation reffects that impact the rapidly dividing cells such as the skin, GI tract, and hematopoietic system usually occurs within

A

during or shortly after radiation therapy
-within the first 3 months

43
Q

Acute radiation shortly after radiation therapy or within the first 3 months typically affects what tissues

A

rapidly dividing cells
-skin
-GI tract
-hematopoietic system

44
Q

radiation therapy
early delayed effects

A

2 weeks to 4 months after RT to neurologic tissues
-suspected to be caused by demyelination or edema associated with cell death

45
Q

Early delayed effects from RT within 2 weeks to 4 months target

A

neurologic tissues
-suspected to be caused by demyelination or edema associated with cell death

46
Q

When do late radiation effects occur

A

3 months to years after RT
-generally irreversible
-late responding tissues are predominantly slowly dividing tissues such as lung, kidney, heart, bone and liver

47
Q

Late radiation effects >3months after RT target

A

late responding tissues are predominantly slowly dividing tissues such as lung, kidney, heart, bone and liver

*generally irreversible

48
Q

radiation effects occur within

A

the radiation field and are releated to the tissues that have been exposed to radiation

49
Q

Radiation effects to skin/fur/hair

A

Acute: alopecia, epilation, erythema, dry desquamation, moist desqyamation, ulceration, necrosis, pain, hemorrhage

Chronic: alopecia, hyperpigmentation or hypopigmentation, leukotrichia, fibrosis, necrosis, pain, induration causing physical impairment, nonhealing wound

50
Q

Why is the a rapid reaction of mucous membranes to RT

A

because the lifespan of the mucous membranes is much shorter than the epidermis

51
Q

What are the effects of radiation to mucous membranes

A

Acute: erythema, mucositis, edema, confluent or patchy white/yellow membrane formation, ulceration, pain, secondary bacterial/fungal infection

Chronic: non-healing ulceration, hyperpigmentation, discoloration

52
Q

What are the effects of radiation to the head/neck

A

Acute: stomatitis, mucositis, pharyngitis, reverse sneezing, esophagitis, xerostomia, thick secretions, cheilosis, ulceration, pain, dysphagia, secondary infection, nasal planum cracking

Chronic: chronic rhinitis, osteoradionecrosis (bone pain, swelling, evidence of infection, exposed bone, nonhealing gingival uclers), xerostomia, trismus with reduced capacity to open mouth

53
Q

What are the effects of radiation to the eyes

A

Acute: keratitis, KCS, blepharospasm, periocular swelling/crusting, corneal edema, corneal ulceration, epilation, conjunctivitis, iritis, retinal edema

Chronic: KCS, telangiectasia, scleral melting, cataract. retinitis, blindness, corneal neovascularization, necrosis

54
Q

How does radiation affect bone

A

Chronic- fracture, necrosis, infection, osteopenia, growth arrest, secondary tumor

55
Q

How does radiation affect the heart

A

Acute and Chronic: pericarditis, restrictive cardiomyopathy, fibrosis, pericardial effusion, cardiac tamponade, pleural effusion, dyspnea, arrythmias, exercise intolerance, heart failure

56
Q

How does radiation affect the bladder

A

Acute/Chronic:
pain on palpation, cystitis, stricture, pollakiuria, stranguria, incontinence, hematuria, fibrosis

57
Q

How does radiation affect the lung

A

Acute/Chronic:
clinical or radiographic signs of pneumonitis (alveolar/interstitial infiltrate) usually 2-8 weeks after radiation,

chronic fibrosis, pneumothorax

58
Q

With radiation, when do you see the radiographic signs of pneumonitis (alveolar/interstitial infiltrate)

A

2-8 weeks after radiation

59
Q

How does radiation affect the GI tract

A

acute/chronic:
diarrhea, vomiting, inappetance, enteritis, hematochezia, sense of urgency, incontinence, stricture, fistula

60
Q

How does radiation affect the CNS

A

Acute/Chronic: neurologic deficits, seizures, ataxia, blindness, paralysis, dementia, somnolence, endocrinopathies, herniation, headache, nausea/vomiting

61
Q

What causes the nausea and vomiting that occurs within hours of irradiating the abdomen

A

5-hydroxytrptamine (5-HT) is released in response to radiation therapy and can stimulate the vomiting center

-Treat with Ondansetron

62
Q

What causes the fatigue that occurs after irradiation of large volume

A

mitochondrial dysfunction and genes related to the regulation of the production of ROS

63
Q

Most effects from radiation are from cell death but what else can occur

A

1) Nausea/Vomiting from 5-HT release
2) Fatigue from mitochondrial dysfunction
3) Somnolence several hours after brain irradiation
4) Acute edema/erythema from inflammation and vascular leakage
5) Pneumonitis due to destruction of type I pneumocytes and an accumulation of inflammatory cells

64
Q

Most cells die by radiation through

A

mitotic cell death which can take time

65
Q

Degranulation with mast cell tumors can occur minutes to weeks after RT. What are the signs? *

A

-Erythema
-Edema
-Hypotension
-Vomiting
-Hyporexia
-Melena
-Coagulation abnormalities

66
Q

What can help you differentiate between tumor recurrence vs infection vs radiation adverse reaction

A

biopsies (fine needle or tissue)

67
Q

What is the goal of treating acute radiation effects

A

improve patient quality of life by minimizing pain, establishing a return to function and ruling out tumor progression/recurrence

68
Q

What should you do for acute skin treatments after radiation

A

-Protect skin from prolonged exposure to heat, cold, sunlight (protect from friction)
-Cleanse irradiated area, if necessary with water, normal saline, or mild diluted soap solution, do not scrub the area, may need sedation/anesthesia
-Antibiotic therapy only if evidence of infection
-Anti-inflammatory therapy with NSAID
-Prevent licking/scratching at irradiated skin, e-collar and hobbles for hind feet
-Oral analgesia medications

controversial: aquaphor, 2% lidocaine helly, SSD

69
Q

How should you treat xerostomia

A

readily available clean water to increase water intake

maintain good oral hygiene

70
Q

How do you treat cracked/dry nasal planum

A

apply balm with soothing ingredients such as hempseed oil, shea butter, cococnut oil, jojoba, vitamin E

71
Q

How should you treat acute stomatitis/mucositis/esophagitis

A

-Maintain good oral hygiene
-soft, bland diet at room temp; avoid salty or acidic foods
-enzymatic mouth rinses, sucralfate solution - magic mouthwash, viscious lidocaine, diphenhydramine, loperamide
-NSAIDs, gabapentin, other oral analgesia meds
-Antibiotic therapy if indicated
-Nutritional support possibly requiring a temporary feeding tube

72
Q

How do you treat eye effects after radiation

A

-topical antibiotics and steroids if no corneal ulceration is present
-topical antibiotics and anesthetics if corneal ulceration present
-supplement eye lubrication if evidence of decreased tear production- Optixcare

73
Q

How do you treat the heart effects of acute radiation

A

Pericarditis managed by prevention on the RT side
-NSAIDs, anti-arrhythmic meds considered, subtotal pericardiectomy if clinical signs present
-Avoid doxorubicin or other anthracyclines, concurrently with RT to the heart

74
Q

How do you treat the bladder effects seen with acute radiation

A

maintain hydration and increase fluid intake to dilute urine
treat underlying infections and use NSAIDs

75
Q

How do you treat the lung effects seen with acute radiation

A

-glucocorticoids, rest, and oxygen therapy for pneumonitis
-antibiotics if needed
-supportive care with expectorants and bronchodilators
-Antitussive medications considered to aid in appropriate sleep

76
Q

How do you treat the CNS effects seen with acute radiation

A

Anti-inflammatory doses of steroids and anticonvulsants as necessary
For herniation from acute edema, consider mannitol or hypertonic saline

77
Q

With chronic treatments, how do you treat fibrosis (chronic)

A

physical therapy, hyperbaric oxygen, pain management, glucocorticoids, pentoxifylline and Vitamin E

78
Q

With chronic treatments, how do you treat lymphedema

A

manual lymphatic drainage (massage), compression bandages, weight management, exercise, skin care, pressure gradient sleeves

79
Q

With chronic treatments, how do you treat chronic rhinitis

A

-Antibiotic therapy if evidence of secondary bacterial infection: consider azithromycin, doxycycline, or metronidazole
-Anti-inflammatory drugs (NSAID or steroids): nasal steroid spray

80
Q

With chronic treatments, how do you treat esophageal stricture

A

dilations and semi-solid diet, feeding tubes, hydrocortisone injection at the stricture site

81
Q

How do you treat osteonecrosis, a chronic manifestation of radiation

A

surgical debridement/intervention
antibiotics
hyperbaric oxygen therapy
-Pentoxifylline and vitamin E

82
Q

How do you treat pulmonary fibrosis, a chronic manifestation of radiation

A

-ameliorated be captopril in human oncology
-oxygen and glucocorticoids as needed
-pentoxifylline and vitamin E

83
Q

How to you treat the bowel effects seen with chronic radiation treatments

A

-increased dietary fiber and probiotics
-analgesia as needed
-viscous lidocaine or silver sulfadiazine for anorectal irritation
-sucralfate enemas for bleeding

84
Q

How do you treat the CNS effects seen with chronic radiation treatments

A

-glucocorticoid ideal in early-onset radiation necrosis
-Pentoxifylline and vitamin E may help in preventing fibrosis
-Consider surgical resection if necrosis is focal and localized

85
Q

What does pentoxifylline do

A

improves blood perfusion by increasing erythrocyte deformability and decreased blood viscosity

86
Q

antioxidant that protects membrane phospholipids from oxidative damage by scavenging reactive oxygen species that are generated during oxidative stress

A

Vitamin E

87
Q

What combination therapy has been shown to decrease risk and even reverse evidence of radiation fibrosis in women who have received breast irridation

A

Pentoxifylline and Vitamin E

88
Q

What can exacerbate radiation side effects

A

Some chemotherapeutics
-Dacarbazine
-Lomustine
-Doxorubicin
-Cisplatin
-Gemcitabine
-Paclitaxel
-Toceranib (for GI ulceration)

89
Q

Why might antioxidants interfere with radiation cell killing

A

antioxidants protect against the damage from the radiation and protect against the humor
dont start during radiation therapy

90
Q

What are possible ocmplications to the oral cabity when doing radiation therapy

A

-Fistula formation
-Candida albicans yeast infection can increase severity of stomatitis/mucositis

91
Q

How do you prevent against side effects from radiation therapy

A

1) IMRT/conformal RT techniques allows for increased dose to tumor while increasing sparing of normal tissues
2) Acute skin effects: reduce skin folds in the treatment field, avoid topical agents immediately before RT, ensure surgical wounds have healed before initiating RT
3) Chronic skin effects- early detection and treatment/management
4) Head and neck effects: pre-RT dental prophylaxis and removal of unhealthy teeth to decrease severity of mucositis and risk of osteonecrosis

ONCOLOGY & CC (6 decks)

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