Test 4 Flashcards
One of the most common malignancies in males, older patients and slow-growing (watch and wait in older patients)
Surgery, RT, or hormonal manipulation; no chemo
Castration or hormonal castration
AP/PA and boots nodes
Immobilization: mid-abdomen to feet; knee sponge, rubber band, sandbags, register table, etc.
Prostate cancer
65% of prostate cancers occur in men over ___ years old
65
3 types of prostate RT
Prostate seeding with iodine or palladium for earlier state disease
EBRT: long treatments
IMRT and VMAT: 3D planning allows conformal dose
Combination of medical/hormonal (gonadotrophin-releasing hormone agonist) or surgical castration with an anti-androgen for the treatment of advanced prostate cancer
Maximal androgen blockade (MAB)
Luteinizing hormone-releasing hormone (LHRH, ex: leuprolide) and gonadotropin-releasing hormone (GnRH) receptor blockers
Hormonal castration
4 things prostate treatment depends on
Patient’s age
Stage/aggressiveness of disease
Underlying medical conditions and patient preference
Gleason score (GS)
2-10 grade of histology of prostate CA; most common morphology (1-5) + highest grade histology (1-5)
Gleason score (GS)
Lateral and posterior borders for prostate cancer
Lat: anterior to pubic symphysis
Post: spare rectum but allow coverage
Superior, inferior, and lateral borders for prostate cancer with LN involvement
Sup: mid-sacrum to L5
Inf: 2 cm inferior to prostate or BIT
Lat: 1.5-2 cm lateral to pelvic brim/bony pelvis
___ field box VMAT, ___-___ field IMRT for prostate
4, 6-7
Less than 35-40% of rectum receiving ___ Gy
60 Gy
Seminal vesicles _______ and _______ to prostate
Superior, posterior
Prostate ___ cm above urethra
1 cm
___ mm margin from GTV and PTV for prostate and ___ mm margin from PTV to block = ___ cm from GTV to block
6 mm
9 mm
1.5 cm
Prostate: ___ Gy in 38 days = ___ cGy per fraction
76 Gy
200 cGy
Early stage six field prostate and SV dose and total dose
Dose: 5940-6000 cGy
Total: 7000-7400 cGy
Prostate dose
LN involvement
Four field pelvis
4500 cGy
Prostate dose
LN involvement
Six field prostate and SV
5940 cGy
Prostate dose
LN involvement
Six field prostate only total
7200-7400 cGy
Prostate clinical trials: 7020 cGy at 270 cGy per fraction = ___ cGy at ___ cGy per fraction
8440 cGy at 200 cGy per fraction
Why are the prostate clinical trials effective?
Rad bio effect very similar; adding dose quicker, less doses/treatment time/patient doesn’t have to come in as much
2 forms of daily IGRT for prostate treatment
US not as common: sonory or iBeam
Gold fiducials
Triangulate marks on port film of prostate and make sure all three points are lined up, now used
Gold fiducials
Parallel opposed fields not used in IMRT because beams can’t face each other or algorithm will fight against itself to get dose to certain area
Optimization