Radiotherapy pt.2 Flashcards
How much of an increase is expected to be seen in cancer incidence in europe?
It has been predicted that in 2035 there will be a 10% increase in the incidence form 2015
What are the pillars of cancer care?
Three pillars: Surgery, radiotherapy, and chemotherapy
What accounts for most cancer cases in europe?
Breast, colorectal, lung, and prostate cancers account for more than 50% of new cases
What accounts for most cancer deaths in Europe?
Breast, colorectal, lung, and pancreatic cancer are the leading causes of deaths
What is the role for the three pillars of cancer therapy?
Surgery.
- locally evident disease
Radiotherapy.
- locoregional disease. Another aim is to eradicate microscopic cancer cells that
surround the macroscopic tumour
Chemotherapy.
- systemic disease
What is chemotherapy?
Destruction of cancer cells using drugs (anti-cancer drugs)
What does the therapeutic choice in cancer treatment depending on?
TNM staging
What is the T criterion in TNM dependent on?
The T criterion is established in 2 ways: dimensions or infiltration of the organ wall. The latter is mainly employed for hollow viscera (like the gastrointestinal tract tumour). Breast, prostate and skin for example have their T based on the dimensions of the primary tumour. On the other hand, GIT tube and bladder tumours are graded based on their invasion of the wall layers (mucosa, submucosa ecc.).
What is the N criterion staging dependent on?
The N staging can depend on number, dimension and site/laterality of the involved lymph nodes
What can metastasis be divided into?
Oligometastatic (usually up to 3 metastasis in the same organ,defined as limited in number and location and are amenable to regional treatment) and plurimetastatic
- Synchronous and metachronous based on the timing of appearance
Synchronous vs metachronous meaning in the setting of metastasis and their implication
- Synchronous means that they are
found at the time of diagnosis of the primitive tumour while Metachronous ones appear during the follow-up
visits - The timing of appearance
has pathological implications: multiple synchronous metastasis or
metachronous metastases after few months from therapy are indicative of an aggressive tumour
What can the different stages of cancer be briefly summarized as?
- Stage I and II (organ limited diseases): early disease, mainly treatable with surgery
- Stage III: locally advanced, the tumour breaks the organ barrier and/or multiple nodal involvement. 60% of cancer patients undergo radiotherapy at least once
- Stage IV: advanced and metastatic disease, requires systemic therapies.
Therapy for different stages of cancer
Stage I generally requires a monotherapy (surgery OR RT)
- Stage II instead frequently requires adjuvant RT if there’s risk of local recurrence.
- On the other hand, stage III diseases
frequently require neoadjuvant therapies to allow an effective surgical procedure.
- Stage IV tumours mainly require
chemotherapy, and RT can have a role
for palliation or consolidation if patients
respond well.
What are radiotherapy aims?
- Eradicates the MACROscopic TUMOR
- Eradicates the MICROscopic tumor cells
- Increases LOCAL CONTROL
- Decreases LOCAL RECURRENCES
- Eradication of METASTATIC disease resistant to CT
- Decreases SYMPTOMS
- Quanitiy of life
- Improve overall survival
- Decreases disease progression
- Quality of life
- Decrease symptoms
What does consolidation mean in RT?
Consolidation means that Chemo acts
on the majority of cancer cells but as a
consequence, some resistant cells might
remain: consolidation RT aims to target
the population of resistant cancer cells.
Indications advantage and applicability of radical RT
- Early tumors and locally advanced tumors
- Avoids demolitive surgery
- Radiosensitive tumors
Label these
