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Terms in this set (32)
1. Cigarette smoking
4. Metals - arsenic, nickel
5. Polycyclic aromatic hydrocarbons
6. Ionising radiation
List 6 risk factors for lung cancer:
3. Haemoptysis (coughing up blood)
4. Chest pain
What are 4 presenting symptoms of a primary lesion lung cancer?
1. Pleural or pericardial effusion
2. Hoarseness of voice
3. Brachial plexus involvement
4. Compression of SVC
What are 4 presenting symptoms of intrathoracic spread of lung cancer?
1. Pain - bone Mets
3. Weight loss
6. Neurological symptoms - brain Mets
What are 6 possible presenting symptoms of distant metastases in lung cancers?
They are a set of symptoms due to the cancer caused by a systemic rather than local effect of cancer cells. Due to an immune response or substances secreted by the cancer.
Describe what paraneoplastic syndromes are
4. Hypertrophic pulmonary oestopathy
What are 4 neoplastic syndromes of lung cancer?
- chest x-ray
- respiratory function tests (spirometry)
- CT of chest, abdomen and brain
- biopsy (fine needle aspiration)
What are some possible diagnostic measures for LC?
If they have resectable disease and acceptable lung and cardiac function with no other commorbidities that would prevent surgery.
When is surgery acceptable for LC patients?
60 Gy in 30 fractions
What is the standard fractionation for LC RT?
It is a precise targeted therapy which minimises dose to surrounding normal tissue. Done in very small fractions but with increased dose (BED>100Gy)
Define stereotactic radiotherapy
54 Gy in 3 fractions
What is a standard SABR fractionation?
It is well tolerated and more convenient for the patient. Results show good local recurrence and overall survival comparable to surgery
Describe the benefits of SABR
- aggressive lung cancer
- normal lung is radiosensitive
- function of uninvolved lung is usually bad because of smoking
List some limitations of RT in LC?
With involved mediastinal nodes or positive margins (50 Gy in 25 fractions with concurrent cisplatin)
When would post-operative RT be given in LC?
Radiation pneumonitis - typically occurs 6 weeks post treatment and presents with shortness of breath, cough, fever and malaise. Treated with prolonged course of steroids.
Describe late effects of irradiation of the lung and its management
- total irradiation dose increasing
- volume of lung irradiated
List the risk factors of radiation pneumonitis
What volume of the lung irradiated will cause grade 3 radiation pneumonitis?
- oesophagus volume treated by more than 50 Gy
- use of concomitant chemotherapy
- aggressive RT fractionation
List risk factors for oesophagitis
- high dose to tumour with good fall off
- dose escalation
IMRT/VMAT advantages in LC RT
- increased low dose to normal lung
- increased low dose wash to normal tissues
Disadvantages of IMRT/VMAT
16 Gy in 2 fractions or 10 Gy in 1
What is a common RT palliative fractionation for poor PS with chest symptoms
36 Gy in 12 fractions with or without chemotherapy
What is a common palliative RT fractionation for good PS with or without symptoms
Carboplatin, vinorelbine, cisplatin
What are some chemotherapy drugs used in LC?
45 Gy in 30 fractions over 3 weeks
What is a common bi-daily fractionation for oesophageal cancer?
Small cell lung cancer has a high incidence of cerebral metastasis, which significantly shortens survival. As the brain is a sanctuary site for chemotherapy the use of PCI should be considered. 25 Gy in 10 fractions to the whole brain.
Describe the use of prophylactic cranial irradiation in LC
1. Palliative RT - bone and brain
2. Palliative surgery - cerebral Mets or prophylactic pinning - bones
3. Palliative chemotherapy
List some palliative treatments for metastatic lung cancer
- fullness in head/headache
- facial swelling
- hoarseness of voice
- distension of superficial chest wall veins
List some signs and symptoms of SVCO
What are some treatments for SVCO
What is the main issue surrounding lung irradiation?
Geometrical miss and blurring of dose (planned is not what is delivered)
What is the effect of respiratory motion in RT?
1. Free breathing motion encompassing
2. Motion suppression - controlled or voluntary breath hold, abdominal compression
3. Motion compensation - respiratory gating and tumour tracking
List some methods to account for respiratory motion
DIBH reduces lung density which allows for dose escalation, it also helps immobilise lung tumours, and can help shift internal structures to a more desirable location.
Discuss deep inspiration breath hold
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