Lec7 Sarcomas and ART

Sarcomas arise from what type of tissue?

a) mesenchymal connective tissue

b) epithelial tissue

c) lymphatic tissue

d) nervous tissue

a) mesenchymal connective tissue

Carcinomas arise from what type of tissue?

a) mesenchymal connective tissue

b) epithelial tissue

c) lymphatic tissue

d) nervous tissue

b) epithelial tissue

What are the two types of sarcomas?

a) Bone and muscular sarcoma

b) Bone and soft tissue sarcoma

c) Soft tissue and brain sarcoma

d) Soft tissue and muscular sarcoma

b) Bone and soft tissue sarcoma

What is the main treatment modality for early sarcomas?

a) Surgery

b) XRT

c) Chemo

d) Hormone

a) Surgery

-surgery using limb sparing techniques T

T/F

Sarcomas are generally very radiosensitive

False

-sarcomas are generally very radioresistant

-therefore high doses are needed (and using ART can help)

-historically soft tissue sarcomas treated with long margins and theyre hard to treat with mets

T/F

An osteosarcoma is the most common type of primary bone cancer

True

-there may be familial and genetic causes, and they occur near sites of bone growth

T/F

Osteosarcoma is most common in teens and young adults

True

-signs + symptoms: pain, sudden fracture, swelling

Where do osteosarcomas usually occur on the bone?

a) Diaphysis

b) Metaphysis

c) Epiphysis

d) Epiphyseal plate

d) Epiphyseal plate

-aka epiphysial line?

When is chemo given for a patient with osteosarcoma?

a) Used as primary treatment

b) Used if there's positive surgical margins

c) Used for palliation

d) Used if disease is high grade

d) Used if disease is high grade

Neoadjuvant chemo often involves which drugs when treating osteosarcoma?

a) Cisplatin and prednisone

b) Fludabarine and busfulfan

c) ADVB

d) Cisplatin and doxorubicin

d) Cisplatin and doxorubicin

What is the general dose for treating osteosarcoma?

a) 55.8Gy

b) 60-66Gy

c) 70Gy

d) 20Gy

a) 55.8Gy

-fair outcomes only

-60-66Gy is a post-op dose with +ve margins

-70Gy is used for definitive local control

Which of the following is a LATE effect of treating a sarcoma?

a) Dysphagia

b) Bone fractures

c) Fibrosis

d) Skin changes

c) Fibrosis

-thickening/scarred tissue

T/F

Soft tissue sarcomas are more common than bone-related sarcomas

True

What is the most common anatomical site for soft tissue sarcomas?

a) Head and neck

b) Retro peritoneum

c) Trunk

d) Extremities

d) Extremities

Which of the following is the most common soft tissue sarcoma that occurs in kids?

a) Medulloblastoma

b) Retinoblastoma

c) Rhabdomyosarcoma

d) Ewing's sarcoma

c) Rhabdomyosarcoma

-Medulloblastoma and retinoblastoma are carcinomas

-kids ~10 yrs old get rhabdomyosarcomas

T/F

Soft tissue sarcomas located in the trunk and head and neck are generally low grade

False

-theyre generally high grade

Which of the following treatments is standard for treating soft tissue sarcomas?

a) Surgery

b) XRT

c) Chemo

d) Observe

a) Surgery

-standard when treating localized soft tissue sarcoma

-wide excision of 1-2cm of healthy tissue is necessary to get -ve margins (including prev. biopsy scars)

-surgical clips remain in place in the cases of positive margins

-limb sparing sx for the extremities

What is the main chemo drug when treating a soft tissue sarcoma?

a) Cisplatin

b) Busulfan

c) Doxorubicin

d) Cyclophosphamide

c) Doxorubicin (aka adriamycin)

-chemo is becoming standard as adjuvant to treatment

-its often concurrent with XRT (so patients may often come in with a chemo pump)

T/F

A thickened pseudo-capsule in soft tissue sarcomas may make for a harder resection, and thus increasing recurrence rate

False

-A thickened pseudo-capsule would make for an easier resection, thus reducing recurrence rate

What is the goal of post-operative radiation when treating a soft tissue sarcoma?

a) Eliminate remaining gross disease

b) Boost the area

c) Prevent local recurrence

d) Treat involved LN

c) Prevent local recurrence

What is the main goal of using adaptive radiation therapy (ARC)?

a) To observe disease progression

b) Improve therapeutic ratio

c) Account for changes in anatomy

d) To make more money

b) Improve therapeutic ratio

Which of the following is TRUE regarding offline ART?

a) Good for fast-growing changes

b) Changes are made during treatment

c) Main form of ART currently

d) Does not affect traditional XRT treatment workflow

d) Does not affect traditional XRT treatment workflow

-offline ART is best for slow and prgressive changes, the changes are made between tx, and is the oldest form of ART right now

Which of the following is FALSE regarding Real-time ART?

a) Requires specialized units (VERO, Cyberknife)

b) Good for respiratory and abdominal targets

c) Conventional CBCT used

d) Evolving technique

c) Conventional CBCT used

-conventional CBCT NOT used with Real-time ART

-it also adds skin dose