Session 2 Review_Radiation and SCLC Flashcards
What is external beam radiation therapy (EBRT)?
Uses a beam of photons or electrons to kill tissues, typically administered over several days.
What is stereotactic radiosurgery (SRS)?
Type of EBRT: Full calculated dose of radiation delivered in one fraction, typically for small tumors.
Typically to brain, spine
What is stereotactic body radiation therapy (SBRT)?
Type of EBRT: 2-5 fractions of highly precise radiation usually to spine, lung, prostate, pancreas, liver - able to give a higher dose of radiation in a shorter period of time.
What is brachytherapy?
Radiation source placed inside or next to the area. Can be low dose or high dose. Helps to focus radiation around the tumor cells and spare healthy cells because it only travels short distances.
List the indications for radiation therapy.
Symptom management, Neoadjuvant therapy, Adjuvant Therapy, Definitive (Curative) therapy.
List the different types of radiation therapy.
External Beam Radiation Therapy, Brachytherapy, Intraoperative Radiotherapy, Targeted Radionuclide Therapy.
What is fractionation?
Each dose of radiation delivered, a fraction of the total dose delivered over time.
Example: 5 Fractions (Fx) of 2 Gray (Gy) = 10 total Gy.
What wavelengths are used in radiation therapy?
Xray, Gamma Rays.
What are the types of External Beam Radiotherapy (EBRT)?
3D-CRT, 4D-CRT, IMRT, VMAT, SRS, SBRT, WBRT.
How long are patient visits, typically, for their radiation therapy?
15-30 minutes.
What is hypofractionation?
Less fractions than standard.
What is hyperfractionation?
More fractions than standard.
What does Gy stand for?
Gray: unit of radiation delivered.
What is the median overall survival for patients with extensive stage small cell lung cancer treated with chemotherapy?
10.5 months.
What is the median overall survival for patients with ES-SCLC treated with chemotherapy AND immunotherapy?
13 months.
What does it mean to be radiosensitive?
Cancer that is highly susceptible to the radiation therapy (tumor cells can easily be killed by radiotherapy).
What does it mean to be radioresistant?
Cancer that is resistant to radiation therapy (tumor cells not so easily killed by radiotherapy).
What is Extensive Stage Small Cell Lung Cancer?
Advanced SCLC that has spread beyond one lung (hemithorax) and may include distant metastases, malignant pericardial or pleural effusions, and/or contralateral lymph node involvement.
Why does Small Cell Lung Cancer have a poorer prognosis compared to non-small cell lung cancer?
Because, although SCLC is very responsive to chemotherapy and radiation initially, it very commonly recurs and subsequent treatments are not as effective. Essentially, lesser treatment options that prolong life. With the exception of newer data coming out related to BiTE therapy.
What are the 4 most common side effects of platinum based chemotherapy?
Myelosuppression, Nausea, Neuropathy, Nephrotoxicity.
What are the 4 most common acute side effects of IMRT (a type of EBRT) to the Head and Neck?
Mucositis, Skin toxicities (localized skin breakdown/burning/itchiness), Dysphagia, Hoarseness.
What are common LATE side effects of IMRT (a type of EBRT) to the Head and Neck?
Xerostomia (dry mouth), Fibrosis, jaw trismus, pharyngeal dysfunction, Thyroid dysfunction, secondary cancers.
When would you expect acute side effects to H&N radiation to start developing?
2-4 weeks after initiation of radiation.
When would you expect acute side effects to H&N radiation to hit its peak?
Right at the completion of Radiation therapy.
When would you expect acute side effects to H&N radiation to start getting better?
1-3 weeks after radiation is completed.
For radiation to treat bone pain, when would you expect pain to improve?
2 weeks to 2 months later.
In ES-SCLC, does WBRT for brain metastases prolong overall survival?
No.
What is the most common side effect to WBRT?
Neurocognitive changes - short term memory processing.
What is the most severe side effect to WBRT?
Radionecrosis.
When would you expect WBRT side effects like neurocognitive changes to occur?
3-6 months after radiation is completed.
Is neurocognitive changes from WBRT reversible?
No, if they occur, they will be long lasting - no treatments found to improve the symptoms after they show up.
What is WBRT?
Whole Brain Radiation Therapy.
What techniques can be done to decrease risk of WBRT side effects?
HA - WBRT + Prophylactic Memantine.
Compare and Contrast Stereotactic Radiosurgery (SRS) and Gamma Knife Therapy.
They have the same goal - really narrowly target brain lesions in a way that puts high intensity radiation to the tumor and spares healthy tissue. They’re different because they use different equipment.
How are Radiation Therapy and Chemotherapy similar?
They are both cytotoxic, cell killing. They both canNOT differentiate between healthy tissue and cancerous tissue.
How does Chemotherapy and Radiation therapy work together?
Chemotherapy can sensitize tissues to make radiation more effective at causing DNA strand breaks and killing the cancer tissues.
Why does radiation get delivered over multiple fractions (doses) typically?
To give healthy tissues time to heal and repair itself.
Is Small Cell Lung cancer considered radiosensitive or radioresistant?
Radiosensitive.
Is Melanoma considered radiosensitive or radioresistant?
Radioresistant.
After initial response to treatment, if a patient experiences relapse of their SCLC, what can they expect their prognosis to be, even with treatment?
2-6 months.
If a patient with SCLC has response to treatment, if they’re going to have relapse of their disease, within what time frame can they expect that to occur?
within 2 years.
What can patients expect their prognosis to be if they have ES-SCLC WITH Brain metastases?
It is shorter than average, could be as short as 6 months even with treatment.
What is HA-WBRT?
Hippocampal Avoidant - Whole Brain Radiation Therapy. A technique to decrease risk of neurocognitive side effects with WBRT.
When might WBRT generally be considered to increase overall survival?
When a patient’s prognosis is primarily being driven by intracranial disease not amenable to SRS.
When might WBRT be useful for symptom management even if it won’t improve overall survival?
When current symptoms from tumor/cerebral edema such as intractable seizures or headaches outweigh the side effects of short term memory processing changes.
What are the advantages of using 3D-CRT for painful spinal metastases?
Can be done quickly and urgently. Can be as short as 1 fraction.
What are the disadvantages of using 3D-CRT for painful spinal metastases?
Does not sculpt away the vital tissues around the spine, so more healthy tissue impacted.
