Visceral Mets

Question 1

Indications for treatment

Answer 1

Indications for treatment:
pain
visceral obstruction
bleeding
other symptoms that negatively impact the QOL

Question 2

Causes of Malignant Lower Airway Obstruction

Answer 2

intrinsic compression (endobronchial tumor)

extrinsic compression (tumor mass in the lung parenchyma or bulky lymphadenopathy during the course of their illness)

Question 3

This modality provides immediate relief on intrinsic compression of the tumor in lower respiratory tract

Answer 3

Interventional bronchoscopy

relief of dyspnea
decreased risk of postobstructive pneumonia
improved functional status

Question 4

Best option for intrinsic compression recurrences after EBRT

Answer 4

Endobronchial brachytherapy

best option for recurrences after EBRT (7.5 Gy × 3 or 10 Gy × 2)

Question 5

endobronchial brachytherapy does not improve symptoms of extrinsic compression of lower urinary tract.

True or false?

Answer 5

True

Question 6

According to the ASTRO Guideline, the usual RT dose for malignant lower respiratory tract obstruction?

Answer 6

30 Gy in 10 fractions or greater

Question 7

According to the ASTRO Guideline, the RT dose for malignant lower respiratory tract obstruction for patients with poor performance status

Answer 7

20 Gy in 5 fractions - poor performance status

Question 8

The major side effect of RT in malignant lower respiratory tract obstruction treatment

Answer 8

Dysphagia

Question 9

most frequent site of distant metastatic disease from:
gastrointestinal tumors (colorectal, esophageal, stomach, pancreatic Ca)
lung cancer
breast cancer
melanoma

Answer 9

Liver metastases

Question 10

In liver metastases, the factors showing good outcomes are?

Answer 10

risk factors with best outcome:

clear resection margins
low levels of CEA
single metastatic deposit
metachronous presentation of the liver metastasis
node-negative disease (with the original primary)

Question 11

In liver metastases, RT can be effective in?

Answer 11

radiation therapy can be effective in palliating symptoms:

more medical comorbidities

greater tumor burden

previously treated with multiple other therapies

Question 12

apparent 1 week to 3 months after treatment
may result in liver failure and death
dose and volume of liver irradiated are important
threshold: 30 Gy in 2 Gy fractions or 33 Gy in 1.5 Gy twice daily fractions (whole liver)

Answer 12

Radiation- induced liver toxicity (RILD)

Question 13

In biliary obstruction

extends stent patency and lengthens survival duration in patients with inoperable cholangiocarcinoma

Answer 13

Intraluminal brachytherapy

Question 14

Most common source pf adrenal metastases

Answer 14

Lung cancer

Question 15

splenomegaly: associated with _________ malignancies and disorders

Answer 15

splenomegaly: associated with hematologic malignancies and disorders (leukemia or myeloproliferative diseases)

Question 16

In splenic metastases,

Is there a role of RT?

Answer 16

reducing the size of the spleen

palliating the other symptoms (splenomegaly)

much lower doses: 0.25 to 1 Gy (2 to 3x/week)

Question 17

What is the initial treatment in vaginal bleeding/discharge?

Answer 17

Vaginal packing

Question 18

Dose for Emergency treatment of vaginal bleed?

Answer 18

radiation therapy (hypofractionated) given at 2.5 to 4 Gy per fraction

30 Gy in 10 fractions

bleeding will slow or stop after 3 to 5 treatments —> continue with standard 1.8 to 2.0 Gy/fx

Question 19

In pelvic recurrence,

for patients with locally advanced recurrent rectal cancer who have no evidence of metastatic disease, IORT can be given at a dose of?

Answer 19

10-30 Gy

Question 20

The most common side effect of IORt and EBRT in pelvic recurrencces treatment

Answer 20

peripheral neuropathy

Question 21

In pelvic recurrences,

ideal for bulky pelvic recurrences with no previous RT

Answer 21

combined chemoRT: ideal for bulky pelvic recurrences with no previous RT

weekly bolus dose of 5-fluorouracil

improve the likelihood of local control

high doses of RT are required for palliation of symptoms

≥50 Gy showed highest response

Question 22

most common sites of metastatic disease:

Answer 22

most common sites of metastatic disease:
 bones
brain
lungs
liver