Radiotherapy And Sarcomas
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This document discusses radiotherapy for soft tissue sarcomas. It notes that sarcomas are a heterogeneous group of rare malignant tumors arising from mesenchymal tissue. Radiotherapy plays an important role in optimizing local control when used as an adjuvant treatment along with surgery. Post-operative radiotherapy has been shown to significantly increase local control rates compared to surgery alone, without affecting patient survival. Both pre-operative and post-operative radiotherapy have been shown to be equally effective, with considerations for each based on anatomical site and tumor characteristics. The document outlines recommendations for indications, planning, immobilization and implementation of post-operative radiotherapy for soft tissue sarcomas.
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This document discusses sarcomas from a surgical perspective. It defines sarcomas as heterogeneous tumors originating from mesoderm or ectoderm. The most common sarcoma subtypes are pleomorphic sarcoma, gastrointestinal stromal tumor, liposarcoma, and leiomyosarcoma. Sarcomas most often occur in extremities, trunk, and retroperitoneum. Diagnosis involves imaging like MRI or CT along with biopsy. Treatment typically involves surgical resection with negative margins, with chemotherapy or radiation used adjuvantly depending on risk factors. Prognosis depends on factors like size, grade, and margin status.
Management of Oral Cavity Cancers
This document provides information on the management of oral cavity cancers. It discusses that oral cavity cancers make up approximately 30% of head and neck cancers, with 80% being tobacco related. The anatomy and subsites of the oral cavity are defined. Pre-malignant lesions that can progress to cancer are described. The pathological classifications, clinical presentation, diagnostic workup, staging, prognostic factors, and principles of treatment for squamous cell carcinoma are outlined. The document discusses the surgical management of the primary tumor and neck, including different types of neck dissections. It also covers reconstructive surgery and the applications and delivery of radiotherapy.
salivary gland cancers management updates
This document presents a case presentation on salivary gland tumors. It outlines the investigations, staging, management, and prognosis of salivary gland tumors. The key investigations discussed are history and physical exam, ultrasound with fine needle aspiration, MRI, and histological diagnosis. Surgical management is the primary treatment and may include parotidectomy or neck dissection. Adjuvant radiation therapy can improve outcomes for high-grade or advanced tumors. Definitive radiation is an option for unresectable tumors. Prognosis depends on factors like tumor site, grade, and stage. Sequelae of treatment include facial nerve damage and xerostomia.
Soft tissue sarcoma
Soft tissue sarcomas are rare cancers that arise from connective tissues. They most commonly occur in the extremities and abdominal cavity. Diagnosis involves biopsy and imaging such as MRI or CT. Treatment is primarily surgical resection with clear margins, sometimes combined with radiation therapy or chemotherapy. Prognostic factors include tumor size, grade, and margin status. Complete surgical removal with negative margins improves local control and survival outcomes for soft tissue sarcomas.
Ca larynx management
This document discusses the management of laryngeal cancers. It covers evaluation by a multidisciplinary team and treatment options depending on the location and stage of the cancer. For early glottic cancers, options include radiation therapy, endoscopic laser resection, or open partial laryngectomy. More advanced cancers typically require total laryngectomy, with postoperative chemoradiation an option. Voice rehabilitation after laryngectomy can involve esophageal speech, an electrolarynx, or tracheoesophageal puncture. Close follow-up is important after any treatment to monitor for recurrence.
TD Vac.pptx
This document discusses soft tissue sarcomas, including:
1. The most common sites are the extremities, intra-abdominal region, and trunk. Risk increases with age, with most cases being diagnosed around age 65.
2. Treatment involves surgical resection with wide margins, sometimes followed by radiation therapy. Preoperative radiation is preferred by some.
3. Specific sarcoma subtypes are discussed, along with their characteristics, risk factors, locations, recurrence rates, and treatments. These include desmoid tumors, dermatofibrosarcoma protuberans, liposarcoma subtypes, leiomyosarcoma, and others.
4. Staging involves imaging of the primary tumor and
Surgical persrective in lung cancer
This document provides an overview of surgical perspectives in lung cancer. It discusses the aims of surgery including complete tumor removal and nodal dissection for staging. Resectability depends on patient factors like age and fitness. Imaging tests and invasive procedures for staging are outlined. Types of operations for early vs advanced lung cancer are summarized including lobectomy, segmentectomy, and extended procedures. Post-operative survival rates are provided by cancer stage. Small cell lung cancer management with a focus on chemotherapy is also reviewed.
Ca Cervix.ppt
This document discusses radiation therapy for carcinoma of the cervix. It provides details on epidemiology, anatomy, staging, imaging, and treatment options. Some key points:
- Carcinoma of the cervix accounts for over 4700 new cases and over 71,000 deaths worldwide each year, with over 80% of cases occurring in developing countries.
- Staging is done according to the FIGO system, which classifies tumors from Stage 0 (carcinoma-in-situ) to Stage IV (distant metastases). Imaging such as CT, MRI, and PET can help determine tumor size, parametrial invasion, and lymph node involvement to guide treatment planning.
- Treatment options include surgery,
Management of Rectal Carcinoma
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Meningioma
Meningiomas are the most common benign brain tumors, arising from the meninges. They occur most often in the 7th decade of life and are more common in women. Risk factors include genetic conditions like NF2 and prior radiation exposure. Common locations include the parasagittal/falcine region, convexity, sphenoid ridge, and posterior fossa. Imaging with CT and MRI is used to characterize the tumor. Surgery is the primary treatment when possible, with the goal of Simpson Grade I resection. Radiation therapy can be used for inoperable or residual tumors. Prognosis is generally good for Grade I meningiomas but poorer for higher grades.
Renal Cancers Rationale
- Renal tumours include renal cell tumours, mesenchymal tumours, and neuroendocrine tumours in both children and adults. Renal cell carcinoma, specifically clear cell RCC, accounts for around 70% of kidney cancers.
- Treatment depends on tumour stage and grade. Organ-confined tumours may be managed with active surveillance, partial or radical nephrectomy. Advanced or metastatic disease may receive chemotherapy, radiotherapy, or targeted drug therapies. Nephrectomy can improve outcomes for metastatic disease.
- Minimally invasive techniques like cryotherapy, radiofrequency ablation, and high-intensity focused ultrasound are alternatives to surgery for select patients. However, long-term outcomes are still best
Renal Cancers Rationale
- Renal tumours include renal cell tumours, mesenchymal tumours, and neuroendocrine tumours in both children and adults. Renal cell carcinoma, specifically clear cell RCC, accounts for around 70% of kidney cancers.
- Treatment depends on tumour stage and grade. Organ-confined tumours may be managed with active surveillance, partial or radical nephrectomy. Advanced or metastatic disease may receive radiation, immunotherapy, targeted drug therapy or palliative care.
- Nephron-sparing surgery aims to preserve renal function when possible for small, low-stage tumours. Complications include bleeding and impaired kidney function.
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Radiotherapy And Sarcomas
- 1. Radiotherapy and Sarcomas Wendy Ella University College London Hospitals NHS Foundation Trust
- 5. Heterogenous group of tumours
- 6. Heterogenous group of tumours
- 7. Heterogenous group of tumours
- 8. Heterogenous group of tumours
- 9. Principles of management: soft tissue sarcomas Surgery +/- Radiotherapy +/- Chemotherapy
- 26. Systematic/Random errors Margin = (2.5 X SD of group systematic error) + (0.7 X SD of random error) - Van Herk, 2004 4.4 mm +/- 0.8mm 0.3 mm +/- 1.5 SD A–P on Lat 5.3 mm +/- 1.7mm -0.2 mm +/- 1.7 SD S-I on AP 4.3 mm +/- 1.1mm 0.2 mm +/- 1.4 SD L-R on AP Margins calculated Group SD of random error Group systematic error
- 28. MRI Scan
- 29. Planning
- 30. Planning
- 32. Questions? University College London Hospitals NHS Foundation Trust
Editor's Notes
- Sarcomas are rare malignant tumours that arise from mesenchymal tissue at any body site. Represents <15 of new malignant tumours diasgnosed. Heterogenous group of tumours including more than 40 subtypes. The tumours appear to arise from malignant precursor cells which can differentiate along one or several linaeges syuch as muscle, adipose, fibrous, cartilage or vascular tissue. Subtypes differ in clinical behaviour and aggressiveness, dissemination pattern and sensitivity.
- Except for small peak in incidence in early childhood (accounted for primarily by embryonal RMS) STS as a whole increases in frequency with advancing age and is most common in patients over the age of 50. Anatomic distribution of soft tissue sarcomas in 4508 adults reviewed by American Colege of Surgery was as follows
- RCT Phase III – Yang et al, JCO, 1998
- Study was not powered to look at local control, PFS or OS, these were all secondary endpoints
- If you had a small lesion that had been widely excised you may not give radiotherapy but this decision needs to on individual basis
- In Canada all patients receive pre-op radiotherapy, UK standard treatment is post op If we give it pre op they receive 50gy then have 4-6 weeks gap prior to surgery and then recive 16Gy boost if positive margins
- Hard when dry and placed in water to soften Optimum position - ? Other leg abducted, flexed out of way?
- Allowing 5-10 mm for set-up error Vortex study suggest 5 mm enough for immobilised patients and 10mm for non-immobilised patients
- Lymphoedema is common even with sparing a corridor so the more limb that can be spared the less risk Caused by fibrosis of skin and muscle
- Smaller margins in Craniocaudal direction, set-up variability will become increasingly important 0.5 To assess if a reduced volume of post-operative radiotherapy increases limb function without compromising local control Suggests that majority of local recurrences occur within the high dose volume
- To ensure that on average 99% target volume receives 95% of prescribed dose
- On anterior images
- Informed consent Follow up on treatment Usually seen week 4 in OPD, weekly by nurses in floor clinic
- Tumour extended distally so leg was externally rotated for treatment and planning