Radiotherapy Flashcards

1
Q

5 Rs of radiobiology

A
Repair
Repopulation 
Redistribution 
Reoxygenation 
Radiosensitivity
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2
Q

Repair

A

Radiation induce DSB and SSB which can induce repair of the cancer cell

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3
Q

Repopulation

A

Cancer cells die and repopulate

The cell death induces inflammation which can can cause more cell death of the cancer cells

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4
Q

Redistribution

A

The cells in certain parts of the cell cycle are more responsive to radiation that other
G2 phase more responsive than G1 not enough time to repair all the chromosomes
So when it divides not sustainable with life so those cells die and leads to a redistribution of cell ages

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5
Q

Reoxygenation

A

Cells that are hypoxic in the middle of the tumour are less susceptible to radiation than the normoxic ones on the outside
So the ones on the outside are killed and the other ones on the inside become normoxic again so more susceptible until the tumour has disappeared

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6
Q

Radiosensivity

A

Some tumours and some cells in the tumour are more responsive than others this could be due to the receptor pathways of those cells

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7
Q

Example RTK mapkinase vs PI3K

A

Mapkinase susceptible as main output is proliferation
So can be affected by radiation in repopulation and redistribution
PI3K concerned with cell survival so not susceptible as others, this is radiosensivity

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8
Q

Proliferation causes stress and stress causes weakness that radiation can attack

A

Damage -> 2 repair pathways A and B
Cancer cell -> A pathway knocked out
Normal both okay
Find a way to knock out repair pathway B cancer cell can be killed by radiation whereas normal cell still has A to repair itself

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9
Q

Radiation dies something to induces angiogenesis

A

Don’t know what he didn’t go into it no notes on lecture

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10
Q

One of cancer hallmarks is resisting cell death what is important about the type of cell death radiotherapy induces

A

If it induces cellular senescence then the cell is immunologically silent immune system can’t see it
Necrosed immune system can and can remove it
Need a way to make all cell death by radiotherapy necrotic

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11
Q

What dies radiation cause

A

DNA damage

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12
Q

What makes cancer sensitive to radiation

A

Hallmarks of cancer

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13
Q

What is dose measured in

A

Gray
Physical quantity describing the amount of energy absorbed from the radiation beam at a given point
1Gy = 1J/1kg

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14
Q

What is the tumour lethal dose

A

Dose of radiation that eradicates the tumour within the treated time
Total number of surviving cells is proportional to the initial number present and the number killed after each dose

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15
Q

What limits the dose

A

Normal tissue tolerance to the radiation

SE

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16
Q

How dies normal tissue tolerance vary between tissues

A
Vascularity 
Immune effects 
Age
Serial vs parallel organs 
Radiogenomics
17
Q

What is the therapeutic index

A
Between dose having an effect to where it becomes too lethal 
85% tumour 
5% SE - worthwhile 
85% tumour 
70% SE - not worth while
18
Q

What is the total dose dependent on ?

A

Intent of the treatment - palliative vs radical
Diagnosis - lymphoma vs HNSCC
Size of treatment volume - T1 larynx or T4N2c Tonsil

19
Q

What determine the treatment time

A

Time taken to deliver the prescribed dose
General rule- the longer the treatment time, the great the dose required
The greater the dose required the longer the treatment time should be

20
Q

What is fractionation

A

Splitting up the dose

Dose delivered per day I.e. Function of total dose and treatment time

21
Q

Why fractionate - repair

A

Small dose a day allows the normal tissue to repair and recover
Differential dsDNA repair between cancer and normal tissue leads to gradual tumour death with preservation of normal tissue

22
Q

What fractionate - redistribution

A

Proliferating tumour cells progress into more radiosensitive part of the cell cycle at each session

23
Q

Why fractionate - repopulation

A

Both normal and cancer cells repopulate
Repopulation is the basis for tissue repair
Repopulation can lead to loss of cure
- accelerated repopulation
Cancer cells respond to cell death by proliferating more quickly for about 4 weeks
Tumour control drops if treatment is prolonged
Basis of twice daily fractionation

24
Q

Why fractionate - reoxygenation

A

Gradual tumour death during treatment normalises vasculature
Hypoxia falls and radiosensivity rises

25
Q

Types of fractionation regimes

A

Conventional
Hyper fractionation
Hypo fractionation

26
Q

What does GTV stand for and what is it

A

Gross tumour volume - the visible tumour assessed by imaging and clinical assessment

27
Q

What does CTV stand for and what does it do

A

Clinical target volume - includes the GTV and the area at risk macroscopic and microscopic disease

28
Q

What does PTV stand for and what is it

A

Planning target volume and it is volume of tissue that should be irradiated to ensure that the CTV is targeted adequately during each fraction
Accounts for any movement, set up error, tumour response during treatment - margin for error

29
Q

Acute SE of radiotherapy

A

Fatigue
Nausea
Dermatitis
Mucositis - eating drinking, communicating, pain and mucus

30
Q

Long term side effects

A

Dry mouth/ taste changes
Skin fibrosis
Dental caries

Rare-
Osteoradionecrosis of the jaw
Stroke
Second malignancy