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Ph RadOnc Residency PBRROE2-3 Review 2021 > Spinal Canal > Flashcards

Spinal Canal Flashcards

1
Q

Spinal Canal

What are the three classifications of spinal canal tumors based on their location relative to the protective layers of the cord?

A

extradural,
intradural–extramedullary,
or intramedullary

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2
Q

Spinal Canal

How many pairs of spinal nerves are there?

A

31 pairs

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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3
Q

Spinal Canal
Spinal cord anatomy

The gray matter is located in the periphery surrounding a central white matter.

TRUE or FALSE?

A

False.

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4
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter controls the motor function

A

anterior horn

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5
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter controls the autonomic functions

A

lateral horns

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6
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter is involved with sensation

A

posterior horn

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7
Q

Spinal Canal
Spinal cord anatomy

the axons of the spinal cord are myelinated

TRUE or FALSE?

A

True

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8
Q

Spinal Canal
Spinal cord anatomy

What transmits muscle stretch and tone sensation from the extremities to the brain?

A

spinocerebellar tract

vibration

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9
Q

Spinal Canal
Spinal cord anatomy

What carries pain fibers to the brain?

A

lateral spinothalamic tract

heat and cold

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10
Q

Spinal Canal
Spinal cord anatomy

What transmits fine touch and positional sensation from the extremities to the brain

A

dorsal column

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11
Q

Spinal Canal
Spinal cord anatomy

At what level does the dural sac ends?

A

S2-3

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12
Q

Spinal Canal
Spinal cord anatomy

At what level does the dura ends?

A

coccyx

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13
Q

Spinal Canal
Spinal cord anatomy

At what level does the subarachnoid space sac ends?

A

S2-3 with the dural sac

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14
Q

Spinal Canal

Most of the primary spinal canal tumors are malignant

TRUE or FALSE?

A

False

Based on population data in the National Program of Cancer Registries (NPCR)
and Surveillance, Epidemiology, and End Results (SEER) programs from 2004
to 2007, 22% of primary spinal tumors are malignant and 78% nonmalignant
(62% benign and 16% with borderline behavior).

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15
Q

Spinal Canal

Most of the malignant spinal canal tumors occcur in males

TRUE or FALSE?

A

False

equally distributed.

Nonmalignant are more common in females.

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16
Q

Spinal Canal

What is the most common histology of spinal canal tumors?

A

Meningioma

followed by nerve sheath, ependymoma, and astrocytoma

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17
Q

Spinal Canal

What is the most common form of treatment failure of spinal canal tumors?

A

Local tumor progression

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18
Q

Spinal Canal

What is the most common presenting symptom of spinal canal tumors?

A

Pain

19
Q

Spinal Canal

The incidence of leptomeningeal spread in patients with primary spinal cord glioma is low overall but is substantially more common with malignant tumors.

Of note, two recently recognized entities have significantly higher risk of leptomeningeal dissemination:

what are these entities?

A

glioblastoma with primitive neuronal component

and

diffuse leptomeningeal glioneuronal tumors (DLGT).

20
Q

Spinal Canal

Differentiate the growth pattern of schwannoma and neurofibrorima in the spinal canal.

A

Neurofibromas typically encase involved nerve roots, whereas schwannomas commonly displace the nerve roots because of their assymetric growth.

NISD

21
Q

Spinal Canal

Differentiate the schwannoma and neurofibrorima in the spinal canal in terms of genetic predisposition

A

neurofibroma (nf1)

schwannoma (nf2)

22
Q

Spinal Canal
Prognostic Factors

In spinal cord astrocytomas, lower grade, younger, age, and surgical resection, and RT are predictors of better OS and cause-specific survival.

TRUE or FALSE?

A

false.

RT is predictor of worse CSS.

(Milano et al.)

23
Q

Spinal Canal
Prognostic Factors

In spinal myxopapillary ependymoma,

older age, adjuvant RT, GTR are associated with improved LC and PFS.

TRUE or FALSE?

A

True

Weber et al.

24
Q

Spinal Canal
Prognostic Factors

In the Mallinckrodt Institute of Radiology experience, Garcia reported that the primary tumor location was the most important prognostic feature.

What location is mostly associated with morbidity and worse outcomes?

A

cervical

25
Q

Spinal Canal
RT

What is the traditional field borders for spinal canal tumors

A

cc: two vertebral bodies above and below

laterally - tips of lateral process

26
Q

Spinal Canal
RT

What is the CTV for low-grade spinal canal tumors

A

preop tumor volume + associated intratumoral cysts
0.5 to 1.5 cm margin.

uninvolved syrinx is not necessarily included

27
Q

Spinal Canal
RT

What is the standard PTV for low-grade spinal canal tumors (no OBI)

A

0.5 cm

28
Q

Spinal Canal
RT

What is the CTV margins for high-grade spinal canal tumors

A

at least 1.5 cm

29
Q

Spinal Canal
RT

What is the CTV for myxopapillary ependymomas of the conus?

A

1.5 cm cephalad and caudad but not beyond the thecal sac.

30
Q

Spinal Canal
RT

When do you include the entire thecal sac in the RT volumes?

A

cauda equina involvement

31
Q

Spinal Canal
RT

Dose prescription
low-grade tumors

A

50.4 (1.8) Gy

32
Q

Spinal Canal
RT

Dose prescription
high-grade tumors

A

54 (1.8) Gy

33
Q

Spinal Canal
RT

Dose prescription
high-grade ependymomas and low-grade astrocytomas

A

50.4 to 54 Gy

34
Q

Spinal Canal
RT

Dose prescription if CSI is needed

A

36 to 45 Gy CSI with boost to gross 50.4 to 54 Gy

35
Q

Spinal Canal
RT

early vs. late myelitis

L’Hermitte’s sign

A

early

36
Q

Spinal Canal
RT

Latency period of chronic myelopathy

A

13 to 29 months

37
Q

Spinal Canal
RT

Chronic myelopathy has a bimodal peak.

This peak corresponds to microvascular injury

A

late peak

38
Q

Spinal Canal
RT

Chronic myelopathy has a bimodal peak.

This peak corresponds to white matter injury and demyelination

A

early peak

39
Q

Spinal Canal
RT

What is the historical maximum tolerance dose of the spinal cord?

A

45 to 50 Gy

40
Q

Spinal Canal
RT

According to QUANTEC, a dose of ___ Gy is associated with 0.2% rate of myelopathy
if given using 1.8 to 2 Gy conventional fractionation

A

50 Gy

41
Q

Spinal Canal
RT

According to QUANTEC, a dose of ___ Gy is associated with 50% rate of myelopathy
if given using 1.8 to 2 Gy conventional fractionation

A

69 Gy

42
Q

Spinal Canal
RT

What situations are associated with lower spinal cord tolerance?

A

children

patients receiving neurotoxic chemotherapy

43
Q

Spinal Canal
RT

Bonus:

What is the Gd variant used to better delineate spinal canal tumors on MRI

A

Gd - DTPA

diethylene-triamine pentaacetic acid

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

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