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Radiation oncology phase B > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Indication of total thyroidectomy in papillary cell carcinoma

A

thyroidectomy (any present): • Known distant metastases • Extrathyroidal extension • Tumor >4 cm in diameter • Lateral cervical lymph node metastases or gross central neck lymph node metastases• Poorly differentiated • Consider for prior radiation exposure (category 2B)• Consider for bilateral nodularity

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2
Q

RAI not typically recommended (if all present):

A

RAI not typically recommended (if all present): • Classic papillary thyroid carcinoma (PTC) • Largest primary tumor <2 cm • Intrathyroidal • Unifocal or multifocal (all foci ≤1 cm) • No detectable anti‑Tg antibodies • Postoperative unstimulated Tg <1 ng/mLq • Negative postoperative ultrasound, if doner

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3
Q

Classification based on iodine concentration

A

Usually Concentrate lodine to a Degree That May Be Curative
Papillary thyroid carcinoma
Classic
Follicular variant
Oncocytic variant
Follicular thyroid carcinoma
Classic
Often Do NOT Concentrate lodine to a Degree That Is Curative
Unfavorable variants of papillary thyroid carcinoma
Diffuse sclerosing
Tall cell
Columnar cell
Hobnail
Hurthle cell carcinoma
Rarely concentrate iodine to a degree that is curative
poorly differentiated thyroid: insular
never concentrate
anaplastic
medullary

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4
Q

Rarely concentrate iodine

A

Rarely Concentrate lodine to a Degree That Is Curative Poorly differentiated thyroid carcinoma: insular carcinoma

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5
Q

Never Concentrate lodine to a Degree That Is Curative

A

Anaplastic carcinoma Medullary carcinoma

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6
Q

RAI typically recommended in

A

RAI typically recommended (if any present): • Gross extrathyroidal extensiont • Primary tumor >4 cm • Postoperative unstimulated Tg >10 ng/mLq,u Bulky or >5 positive lymph nodes

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7
Q

Risk factors for thyroid carcinoma

A

Radiation exposureReduced iodine uptakeGenetic factors: MEN

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8
Q

Disease mentioned by MEN 1, 2a,2b

A

MEN 1: pituitary adenoma, parathyroid, pancreaticMEN2: parathyroid, phaechromocytoma, medullaryMEN 2b: phaechromocytoma, medullary, mucosal neuromas

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9
Q

Indications for total thyroidectomy or lobectomy, if all criteria present?

A

:• No prior radiation exposure• No distant metastases• No lateral cervical lymph nodemetastases• No extrathyroidal extension • Tumor 1–4 cm in diameter

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10
Q

N1a level means

A

N1a Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral disease

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11
Q

N1b

A

N1b Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes

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12
Q

RAI - I3 I dose

A

30mci= all other cases150mci= pt3b, >_4Ln, ene that is not extensive, positive margin and tag>_1.0 200meli = PTA4) extensive one,m1

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13
Q

prognosis of medullary thyroid carcinoma

A

75% have 5 year survival: local25% 5 year survival if metastatic

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14
Q

anaplastic prognosis

A

1% of thyroid cancer, 1 year survival 20% and median survival 5 months

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15
Q

Prgognostic MACIS score for thyroid cancer in differentiated

A

M: metastatisA-ageC- completeness of resectionI: invasionS=sizepoint: Age 39 yrs: 3.1age >-40 3.1x.08tumor size: size in cm x 3R1/R2: 1locally invasive 1DM: 3

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16
Q

MACIS score

A

low risk <6intermediate risk 6-6.99high risk: 7-7.99

17
Q

prognostic factors for medullary thyroid cancer

A

host related: age <40gender -male(poor)tumor related:stagevascular invasionCEA levelcalcitonin doubling time( 6-12 months, good)RET mutation, MEN2B

18
Q

which mutation have to be screened for medullary carcinoma

A

RET proto oncogene

19
Q

classification of thyroid cancer by cell of origin

A

follicular epithelial cell
well differentiated thyroid cancer
papillary thyroid cancer
classic
follicular variant
oncocytic
unfavorable
-diffuse sclerosing
-tall cell
-columnar cell
-hobnail
follicular thyroid carcinoma
classic
hurthle cell
poorly differentiated
insular
undifferentiated thyroid
anaplastic
parafollicular
–medullary

20
Q

Survival rate of different thyroid cancer

A

papillary: 80-90% of thyroid cancer. 95% 10yr OS
follicular
85% 10 yr OS
hurthle cell
75% 10yr OS
medullary
2% of thyroid. 75% 5 yr survival
anaplastic
20% 1 yr survival

21
Q

Thyroid radiation dose

A

WDTC or medullary cancer
60 Gy in 30 daily fractions given in 6 weeks to PTV60.
66 Gy in 33 daily fractions given in 6 1⁄2 weeks to PTV66 if defined.
Anaplastic cancer
20 Gy in 5 daily fractions of 4 Gy given in 7 days.
30 Gy in 6 fractions of 5 Gy given in 2 weeks.
55 Gy in 20 daily fractions of 2.75 Gy given in 4 weeks if high dose treatment.
appropriate (35.75 Gy in 13 fractions to PTV35, 19.25 Gy in 7 fractions to PTV55)

Radiation oncology phase B (33 decks)

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