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Cancer Pharmacology > Radiotherapy > Flashcards

Radiotherapy Flashcards

1
Q

What is the primary treatment for breast cancer?

A

Surgery

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2
Q

What is the primary treatment for oral pharynx cancer?

A

Radiotherapy

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3
Q

What is the primary treatment for small cell lung cancer?

A

Chemotherapy

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4
Q

How many patients in the UK at treated with radiotherapy at some point during their disease?

A

~50%

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5
Q

How many patients in the UK are hugely impacted by radiotherapy?

A

~20%

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6
Q

What are the 3 phases of a cell and tissues response to radiation?

A

The physical
The chemical
The biological

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7
Q

Describe the physical phase

A

Deposition of energy: isolation and production of fast electrons
Direct action of radiation - electrons damage DNA

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8
Q

Describe the chemical phase

A

Electrons interact with molecules to produce chemical changes: Free radical damage biological targets - indirect action

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9
Q

Describe the biological phase

A

The chemical damage has biological effects

The whole system

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10
Q

In terms of organic radicals, how does hypoxic conditions effect the cell?

A

The damage can be repaired and therefore the tissues are resistant to damage via radiation

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11
Q

What is the effect if the cells are well-oxygenated?

A

Organic peroxide is formed and the tissues cannot repair the damage since the organic peroxide fixes the damage

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12
Q

What is physical dose?

A

A measure of the energy deposited in the medium or the kinetic energy transferred

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13
Q

What does the biological effect of a physical dose dependent on?

A

The type of radiation
Number of fractions into which dose has been divided
Interval between fractions
The time the radiation is received
Dose rate of each individual fraction
Biological tissue/ endpoint under consideration

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14
Q

What are the two types of radiation?

A

Alpha particles

500NEB X-rays

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15
Q

What is the difference between the types of radiation?

A

Alpha particles produce more ionisation per dose than x-rays, therefore, alpha particles have a greater biological effect

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16
Q

How many Grey are fatal?

A

10 Grey

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17
Q

How many joules is 10 Grey equivalent too?

A

700J

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18
Q

Why does 700J kill you?

A

Due to the quantisation

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19
Q

What is quantisation?

A

It is put into a small package rather than a large distribution

20
Q

Why is personalised medicine needed for radiotherapy?

A

We normally give the wrong dose of the drug

21
Q

What are acute effects?

A

Occur at or around the time of radiation

Effects on the tumour appear to be parallel with the effects on normal cells

22
Q

What are late effects?

A

Develop after 6 months of irradiation

23
Q

Name a late effect of radiotherapy in breast cancer patients

A

They can develop cardiovascular disease

24
Q

How long can the late effects of radiation occur for?

A

Can still occur 20 years later

25
Q

What is the main issue with radiotherapy?

A

It targets well oxygenated cells
Normal cells are well oxygenated
Cancer cells tend to be hypoxic

26
Q

What are the 5 R’s of radiobiology?

A 
Repair 
Repopulation 
Reoxygenation 
Redistribution 
Radiosensitivity
27
Q

What is reoxygenation?

A

during therapy, tumours reoxygenate - may be how some cells are responsive to therapy

28
Q

What is redistribution?

A

During the cell cycle, the tumours have high levels of oxygenation

29
Q

What is radiosensitivity?

A

Why some cells resist therapy and others don’t

30
Q

What types of damage can radiotherapy and chemotherapy induce?

A 
Missing base 
Single-strand break 
Bulky adduct 
Replication error (wrong base)
Double-strand break
31
Q

What repair mechanisms counteract the damage induced by radiotherapy and chemotherapy?

A

Base excision repair
Nucleotide excision repair
Mismatch repair
Homologous recombination end joining

32
Q

What are the clinical advantages of radiotherapy?

A

Elimination of adjacent pre-malignant cells
Increased killing of tumour stem cells
Differentiation of undifferentiated tumour cells
Increased proliferation of normal cells
Increased radioresistance in adapted normal cells
Rapid relief of symptoms

33
Q

What are the clinical disadvantages of radiotherapy?

A 
Second malignancies 
Increased acute toxicity 
Increased proliferation of tumour cells 
Increased radioresistance in adapted tumour cells 
Increased systemic effects 
Late organ damage
34
Q

What is radiogenomics?

A

The study of the link between germ line genotypic variations and the large clinical variability in response to radiotherapy

35
Q

How can radiation effect genes?

A

It can upregulate and downregulate them

36
Q

How can you use proteomics to see if a patient will respond to radiotherapy?

A

Look for hypoxic gene signatures in the tumour

37
Q

How much does nimorazole cost per patient?

A

25 dollars

38
Q

What is the function of nimorazole?

A

Sensitises hypoxic cells

39
Q

What cancer responds well to nimorazole?

A

Head and neck cancer

40
Q

How could you improve nimorazole distribution?

A

Use gene signatures to see if a patients tumour is hypoxic

It is more effective in more hypoxic cells

41
Q

Describe the concept of self-vaccinating

A

Radiation produces massive cell death -> releases a lot of antigens into the blood -> encounters the immune system -> immune system produces anti- tumour antibodies

42
Q

What is the issue with combining radiotherapy with immune modulation?

A

You could overwhelm the immune system and paralyse it

43
Q

What is cyberknife?

A

a multidimensional planning couch and treatment head moves

Patients lay on the coach, the machine goes around and it irradiates the bits you want to irradiate

44
Q

What is the novalis system?

A

A radiotherapy machine which rotates 360 degrees without moving a mm

45
Q

What is tomotherapy?

A

CT scanner in reverse
the patients move through the tunnel and there is an array of x-rays targetting the tumour
you know you are targetting the tumour since it takes pictures throughout

46
Q

What can go wrong with modernised machines?

A

They are all controlled by algorithms so if the algorithm is wrong it’ll target the wrong thing

Cancer Pharmacology (13 decks)

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