cancer managment

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Author:
moostacheroc
ID:
253096
Filename:
cancer managment
Updated:
2013-12-14 07:30:36
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cancer managment radiation therapy part
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Description:
Intro to Rad Onc
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  1. Td5/5
    normal tissue tolerance dose in terms of the total dose delivered by a standard fractionation schedule that causes a minimal 5%complication in 5 years
  2. Td50/5
    normal tissue tolerance dose in terms of total dose delivered by a standard fractionation schedule that causes a maximal 50%0 complication rate in 5 years
  3. what two factors affect the NTTD?
    the volume irradiated and fraction size
  4. as volume of the organ affected by the treatment increases the tolerance dose for the organ?
    decreases
  5. as the size of the daily fraction increases the tolerance of normal tissue?
    decrease
  6. Lung td5/5
    1750cGy
  7. lung td5/5 (1/3 lung)
    4500cGy
  8. endpoint for Lung
    nephritis
  9. spinal cord td5/5
    4500-4700cGy (20cm)
  10. spinal cord end point
    Myelitis Necrosis
  11. Small Bowel td5/5
    4000cGy
  12. Small bowel endpoint
    obstruction / perforation
  13. Rectum td5/5
    6000cGy
  14. Rectum end point
    Necrosis proctitis
  15. Gross tumor volume GTV
    all known disease including abnormally enlarged regional lymph nodes
  16. Clinical target volume CTV
    encompasses the gtv plus regions presumed to harbor potential microscopic disease/ margin of at least 1-2 cm around tumor.
  17. GTV + CTV = ?
    TUMOR VOLUME
  18. INTERNAL TARGET VOLUME
    ACCOUNTS FOR PHYSIOLOGICAL PROCESSES SUCH AS RESPIRATION HEARTBEAT RESPIRATION
  19. PLANNING TARGET VOLUME
    • PROVIDES MARGIN AROUND CTV TO ALLOW FOR VARIATION OR UNCERTAIN IN THE CTV
    • GTV+CTV+PTV = TARGET VOLUME
  20. ACUTE EFFECTS OF RADIATION
    NORMALLY REVERSABLE AND MAY OCCUR DURING OR SOON AFTER IRRADIATION.
  21. EXAMPLES OF ACUTE EFFECTS
    ESOPHAGUS-ESOPHAGITIS 3-4 WEEKS POST

    LUNG-PNEUMONITIS 3MONTHS POST
  22. CHRONIC EFFECTS
    IRREVERSIBLE ACUTE EFFECTS DUE TO DEPLETION OF NONPARENCHYMAL CELLS NORMALLY OCCURS MONTHS TO YEARS AFTER RADIOTHERAPY.
  23. MOST RADIOSENSITIVE TISSUE CELLS
    STEMM CELLS SUCH AS BONE MARROW,INTESTINAL EPITHELIUM AND GONADAL EPITHELIUM
  24. TISSUE RESPONCE DEPENDS ON WHAT 2 FACTORS?
    INHERENT SENSITIVITY OF THE VARIOUS CELL POPULATIONS IN THE TISSUE OR ORGAN/TUNROVER KINETICS OF EACH CELL POPULATION
  25. What did Bergonie and Tribondeau observe?
    Immature dividing cells were damaged after lower doses of radiation than were the mature nondividing cells.
  26. Radiation is more effective against cells that are?
    • 1. actively dividing
    • 2. undifferentiated
    • 3. long mitotic activity
  27. High sensitivity cell
    Vegetative intermitotic cells VIM
    rapidly dividing cell/undifferentiated/ basal cells, crypt cells, erythroblasts, spermatogonia
  28. Differentiating intermitotic cells DIM
    actively dividing
  29. Reverting post mitotic cells RPM
    USUALLY DONT DIVIDE BUT ARE CAPABLE OF DIVIDING (LIVER CELLS,LYMPHOCYTES
  30. FIXED POST MITOTIC CELLS FPM
    DO NOT DIVIDE  WELL DIFFERENTIATED (NERVE, MUSCLE,ERYTHROCYTES)
  31. WHAT RPM CELL IS HIGHLY SENSITIVE?
    LYMPHOCYTES
  32. STOMA OF THE TISSUE
    SUPPORT (BLOOD SUPPLY
  33. PARACHYMA
    FUNCTIONAL PART OF THE TISSUE/ORGAN
  34. TUMOR LETHAL DOSE
    A CERTAIN DOSE CAN BE ASSIGNED FOR EACH TYPE OF TUMOR, WHICH WILL CAUSE DESTRUCTION OF A HIGH PROPORTION OF ITS CELLS
  35. NORMAL TISSUE TOLERANCE DOSE
    THE MAXIMUM DOSE WHICH CAN BE DELIVERED WITHOUT IRREPARABLE DAMAGE
  36. BONE TUMOR TLD
    8000CGY
  37. SKIN TOLORANCE
    5000cGy
  38. WHAT MUST THE THERAPUTIC RATIO BE TO HAVE A MORE SUCCESSFUL ERADICATION?
    • TERAPUTIC RATIO GREATER THAN 1
  39. NATURAL RADIOSENSITIZER
    OXYGEN
  40. ASPECTS OF THE CELL SURVIVAL CURVE
    • SHOULDER/
    • DQ THE QUASI THRESHOLD DOSE where equal increases of dose do not cause a corresponding equal decreas in surviving fraction 

    D0/D37 =37% CELL SURVIVAL
  41. hypoxic cells
    low oxygen and are 2.5-3x more radioresistance than fully o2 cells
  42. oxygen enhancement ratio OER
    the dose of radiation that produces a given biological response in the absence of oxygen divided by the dose of radiation that produces the same biological response in the presence of oxygen
  43. 4 "R" of radiobiology
    • repair
    • reoxygenation
    • repopulation
    • redistribution/reassortment
  44. Conventional fractionation
    180cGy per fraction 5x a week
  45. protracted fractionation
    160-170cGy 5 fraction/week total dose is increased by 10%
  46. how long for normal cell repair
    4 hours
  47. how long for cancer cell repair
    6hrs
  48. accelerated fractionation
    size and dose are similar to conventional fract. results in a shorter overall treatment course
  49. hyperfractionation
    same as treatment course as conventional but has a greater dose to tumor
  50. what 2 Rs do you want for normal cells?
    repair and repopulation
  51. what 2 Rs do you want for cancer cells?
    reoxygenation and redistrubution

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