exam 1

When doing radiation treatment to the lit? Where is the shielding placed?

Inside the lip

Electron treatment is usually placed to what Isodose line

90%

For electrons what is usually required to enhance the surface dose?

Bolus

What are the different treatment options for skin cancer SSC and BBC

Moe’s surgery, radiation therapy, chemo

What are the factors that influence treatment decision for SCC and BCC?

Size, anatomical, location, involvement of cartilage, or bone, depth of invasion, grade, previous treatment, condition of patient

What are the two main causes of skin cancer?

UV rays from the sun for tanning beds and genetics

Which layer of the skin is the most sensitive to radiation?

The epidermis

The outermost layer of the skin is called

The epidermis

What is the most common skin cancer histology?

Basal cell carcinoma

What is the main treatment option for non-melanomas

Surgery

Electro dedication and curettage is used for

Small BCC less than 1.5 cm

Horse skin cancer radiation therapy is indicated for lesions

Larger than 2 CM has deep fixation or involvement of adjacent structures

For skin, cancer doses, and fractionation depend on

His style logic, type size and depth

A typical daily dose for basal cell carcinoma is

2 to 5 gray

The typical total dose for basal cell carcinoma, and fractions is

30 to 50 gray and 6 to 20 fractions

Squamous cell carcinoma, typical total dose and fractionation is

50 to 60gray and 15 to 30 fractions

Most skin cancers are treated with what type of radiation And why?

Electrons because it has a rapid dose fall off

What other radiation therapy techniques can be used for skin cancer non-melanoma

IMRT, brachytherapy, KV

What type of radiation therapy technique is used for locally advanced lesions of head and neck, particularly for disease requiring tracking of nerves

IMRT

Choice of field orders for skin cancer depends on

Size of tumor and quality of the beam

Radiation field orders for skin cancer should include a margin of

2 CM to 2.5 CM

For skin cancers that are up to TCM what are the proton and electron margins

Photo margins of 0.5 to 1 cm and electron margins of 1 to 1.5 CM

For skin cancer that is greater than two CM what are the photon and electron margins?

Botan margins of 0.5 to 1 CM electron margins of 2 to 2.5 CM

What is the main treatment option for melanoma?

Wide local excision that consists of an N block removal of the tumor

What are the treatment options for melanoma?

Typically, surgery, radiation, therapy, isolated, limb, perfusion, and chemotherapy. Immunotherapy are often used as a treatment for melanomas that have metastasized.

What is the conventional total dose for melanoma?

60 to 70 gray

What is the hyper fractured dose for melanoma?

50 to 55 gray

Radiation therapy treatment for melanoma plays a role in

Treatment for an operable patients or patient with an inability for further resection or to treat palliative patients

What is different about radiation treatment for melanoma

We have to use higher than conventional doses per fraction

What are the acute side effects Of skin cancer treatment

Erythema, hyper/hypo pigmentation, dry, disclamation, moist, disclamation, temporary hair loss

What are the latest side effects of skin cancer treatment?

Fibrosis, hypo pigmentation and increased sound sensitivity, necrosis, more susceptible to injury, telangiectasia

What are the critical structures when treating skin cancer?

Eyes, sensory nerves, accessory nerves, blood vessels, ear canal, gums, tongue, teeth

Treatment options for high-grade, gliomas, and GBM

The usual treatment is surgery and postop radiation therapy and chemotherapy temozoloide

Treatment techniques used for GBM and high-grade gliomas

SRS, IMRT and VMAT, partial brain, radiation and whole brain radiation for multifocal lesions or unresectable

What are the critical structures for treating brain?

Lens, lacrimal gland, optic cam, optic nerve, brainstem, spinal cord

What is the typical dose for In fractionation for GBM and high-grade gliomas

60 gray and 30 to 33 fractions

What is the patient positioning for a GBM?

S frame mask can be supine or prone

What are the field borders for a GBM/high-grade glioma

2 to 3 cm margin is placed around the contrast, enhance tumor and edema. You can use two or more treatment fields.

Treatment options for low grade gliomas

The usual treatment is a maximal surgical resection and radiation therapy can be used for unresectable, tumors or residual cancer cells

The radiation techniques used for low-grade glioma’s consist of

IRT, 3-D conformal, SRS, protons

The typical dose for low-grade gliomas is

50.4 to 54 gray

The field border is for low-grade gliomas is

A 1.5 cm clinical target volume beyond the lesion plus an additional 0.5 cm for the planning target volume for 3-D and I MRT

Treatment options for brain stem, gliomas

Radiation therapy is main stay and corticosteroids are usually necessary to stabilize neurologic symptoms

Radiation therapy techniques used for brainstem glioma

I MRT/VMAT, 3-D, SRS, opposed laterals, CSI for high risk patients

What is the conventional dose for brain stem gliomas?

180 centigrade per fraction for a total of 54 to 60 gray

What is the patient positioning for brainstem glioma?

Mask with anesthesia and can be supine or prone

What are the field borders for brainstem glioma?

For diffuse lesions, inclusion of the entire brain stem from the Dicencephalon to C2. The cerebellar extension must also be covered with a 2 to 3 cm margin.

What are the treatment options for medulloblastoma?

Complete resection RT to the cranial spinal axis, followed by a boost to the posterior faucet or tumor Bed and chemo

Radiation therapy technique used for medulloblastoma

Cranial spinal

Typical radiation dose for medulloblastoma

Total dose of 54 to 55 grey 1.6 to 1.8 gray Per fraction

What are the field borders for medulloblastoma?

It is important to include the cribiform plate in the anterior vasa and the radiation volume because of reoccurrences

The field should include the entire skull and lateral margin to include a width of the vertebrae with 1 to 1.5 cm margin the field should end at as S2

What is the patient positioning for a medulloblastoma?

Usually prone to expose the posterior faucet mask and an immobilization cast/vacuum device

What are the treatment options for meningioma?

Primary auction surgery and adjuvant RT may be used

What are the treatment techniques used for meningioma?

SRS, 3-D, IMRT, EBRT

What is the typical dose for meningioma?

54 to 60

What are the field borders for meningioma?

Benign meningioma consists of a 1 cm margin beyond the tumor volume and form malignant Meningioma It is a 2 to 3 cm margin.

What are the treatment options for CNS lymphoma?

Surgical resection is not necessary chemo radiation may be good for elderly patients and radiation is used for patients that are not chemo eligible

What are the radiation therapy treatment techniques used for CNS lymphoma

Whole brain, radiation therapy, IMRT, SRS

What is the dose for young patients with CNS lymphoma getting whole brain?

23.4 grey

What is the whole brain radiation therapy dose?

Total dose is 30 gray with three gray per fraction

What is the German helmet?

It is used in whole brain RT and it uses MLC’s to better block the orbits and conform the treatment from a CT sin

Whole brain radiation is administered through what type of fields

Parallel opposed fields

In whole brain radiation therapy what can help reduce divergence

Have beam blocking

How much flash should be seen at the anterior posterior and superior borders in WBRT

1 cm

SRS is

A delivery of a single high dose of ionizing radiation to a Small target with limited dose to surrounding tissue

The margin of SRS should be

Spherical and only up to three CM at its maximum dimension

SRS is good for what type of brain lesions

Isolated and solitary brain mets

Can you spinal RT is commonly used for what CNS tumors

Medulloblastoma and ependyoma

What is the treatment techniques for cranial spinal RT?

Uses a combination of WBRT and spinal radiation

It uses two lateral whole brain fields in one or more posterior spinal Fields

Need to match matching beam divergent by feathering

How do you feather for cranial spinal RT?

By shifting the gap 1 cm every 1000 C

How much gap is usually left between a budding fields?

0.5 cm

Acute side effects of treating brain tumors

Hair loss, erythema, tanning, dry, and moist exclamation, edema, nausea, vomiting, otitis externa, Drowsiness, lethargy, decreased mental sadness

What side effects can occur from cranial spinal treatment

Mucositis esophagitis and diarrhea

What are some late side effects of treating CNS tumors?

Radiation necrosis, cataracts, hormone, insufficiency, emotional distress, for children. It has been linked to a significant decrease in IQ scores.

Nasopharyngeal treatment options

Surgery is challenging so RT is the main stay for early tumors for more advanced tumors chemo radiation is used

Radiation treatment techniques used for nasopharyngeal cancers

IRT and daily image, guidance, break therapy

What are the anterior superior and posterior fieldworkers for nasopharynx?

Anterior is 2 to 3 cm anterior to the GTV

Superior is the entire paranoid, sinus, and base of skull

Inferior is matchup plain above true vocal cords

Posterior is behind the spinous process

What is the patient position for nasopharyngeal cancer?

The neck is extended And a tongue blade with a cork attached to one end is inserted between the incisor teeth to depress the tongue. The head is a immobilized.

What is the typical dose for nasopharyngeal cancer?

Initial is 5040 cgy, 40 grey off cord

Boost for early tumors is 65 gray for advanced tumors. It’s 70 to 75 gray.

Acute side effects for treating Nasopharyngeal cancer

Mucositis dermatitis xerostomia

Late side effects for treating Nasal pharyngeal cancer

Soft tissue fibrosis, trismus, hearing loss, osteonecrosis

Radiation therapy techniques used for oral pharyngeal cancer

Radiation therapy is the treatment of choice for early tumors. You can use 3-D but IRT is the preferred method because it reduces dose to the salivary glands and auditory structures.

Patient positioning for treating the oral pharyngeal cancer

Patient is supine with a thermoplastic mask and a bite block, stent or tongue blade may be used

What is the field borderers for treating oral pharyngeal cancer?

The anterior is 2 cm anterior to the tumor. The posterior is behind the spine process. The superior is the entire Jugular chain and above C1 and the inferior is the thyroid notch

What is the 3-D conformal dose for oral pharyngeal cancers?

70 gray

What are the acute side effects for treating oropharyngeal cancer?

Mucositis, xerostomia, Taste altercation

What are the latest side effects of treating oropharyngeal cancer?

Osteoradionecrosis, dysphasia, ricinus, hypothyroidism, voice altercation, altered taste

What are the treatment options for treating hypopharyngeal cancer?

Early stage tumors are usually treated with surgery and postop RT locally advanced tumors are treated with concurrent chemo radiation

What are the radiation therapy techniques used for treating hypo pharyngeal cancers?

Image guided IMRT is preferred. You can do pre-operative and postoperative RT.

Opposed lateral fields are used

Anterior spinal shield is used but not in the initial 46 gray

Patient positioning for treating hypo pharyngeal cancer

Supine with the head, hyperextended shoulders may be pulled down with straps. Use an S frame mask and a bolts may be used for anterior, commissure tumors, and over tracheotomy

What are the field borderers for treating hypopharyngeal cancer

Interior is in front of the thyroid cartilage that they margin around turmeric extension

Posterior is behind the spine process with a margin on all nodal

Superior is the inferior border of mandible and mastoid process to base of skull

The inferior is below the cricoid cartilage to encompass the tumor extent with a 1.5 to 2 cm margin

Treat primary and level two to level four and retropharyngeal notes in all cases

What is the typical dose for definitive, preop, and postop hypopharyngeal cancer

Definitive is 70 to 75 gray, preop is 45 to 50 gray, postop is 60 gray

What is a vertex field?

A field use for SRS treatments when a couch is rotated 90° and the gantry is also rotated 90°