96.2 📚 國考版醫垫國考 / PGY OSCE

96.2.0.1 📌 Cram Sheet

96.2.0.1.1 🔥 高 yield 10
  1. Liposarcoma most common adult STS
  2. GIST KIT+/PDGFRA+ = imatinib paradigm
  3. Osteosarcoma 15-25 yr metaphysis: MAP chemo + surgery
  4. Ewing: EWS-FLI1 t(11;22); VAC/IE
  5. Sarcoma loves lung mets
  6. Li-Fraumeni (TP53) osteosarcoma + STS
  7. NF1 → MPNST
  8. Synovial sarcoma: SS18-SSX
  9. Bone mets sources: breast, prostate, lung, RCC, thyroid, MM
  10. Bone modifying: zoledronic / denosumab / radium-223 (prostate)
96.2.0.1.2 🔢 必背
Tumor Genetics
Osteosarcoma TP53 (Li-Fraumeni), RB1
Ewing EWS-FLI1 t(11;22)
Synovial SS18-SSX
GIST KIT+ / PDGFRA+
Chordoma EZH2
MPNST NF1 loss
Rhabdomyosarcoma PAX3-FOXO1 (alveolar)
Angiosarcoma KDR
項目 æ•žå­—
Osteosarcoma age 15-25 yr
Ewing age Adolescent
Imatinib GIST 400-800 mg/d
Adjuvant imatinib 3 yr (high-risk)

96.2.0.2 ⭐ 高 yield

96.2.0.2.1 GIST Treatment Ladder
  1. Imatinib 400 mg
  2. Imatinib 800 mg (KIT exon 9)
  3. Sunitinib (post-imatinib)
  4. Regorafenib
  5. Ripretinib
  6. Avapritinib (PDGFRA D842V — only)
96.2.0.2.2 Sarcoma Drugs Quick
Drug Use
Doxorubicin Backbone STS
AIM (doxorubicin + ifosfamide + mesna) High-grade STS
Pazopanib Refractory STS
Trabectedin Post-anthracycline STS
Eribulin Liposarcoma + leiomyosarcoma post-anth
Larotrectinib NTRK fusion
Tazemetostat EZH2 / INI1-loss
Ipilimumab + nivolumab Alveolar soft part
Imatinib GIST
MAP (high-dose MTX + doxorubicin + cisplatin) Osteosarcoma
VAC/IE Ewing
96.2.0.2.3 Bone Mets Treatment
  • Bone-modifying agents:
    • Zoledronic acid (q3-4 wk for cancer)
    • Denosumab (anti-RANK-L; q4 wk for cancer)
    • Radium-223 (alpha-emitter; prostate bone-only mets)
  • RT for pain (single 8 Gy effective)
  • Prophylactic fixation if Mirels score ≥ 9
  • Treat underlying cancer
  • SCC emergent (Ch 80)
96.2.0.2.4 Mirels Score (Pathologic Fracture Risk)
  • Site, pain, lesion, size
  • ≥ 9 = prophylactic fixation
  • < 7 = conservative

96.2.0.3 🎯 自我檢枬

  1. Most common adult STS? → Liposarcoma
  2. GIST genetics? → KIT+ / PDGFRA+
  3. GIST 1st? → Imatinib
  4. PDGFRA D842V drug? → Avapritinib
  5. Osteosarcoma age? → 15-25 yr
  6. Osteosarcoma chemo? → MAP
  7. Ewing fusion? → EWS-FLI1 t(11;22)
  8. Ewing chemo? → VAC/IE
  9. Sarcoma mets favorite? → Lung
  10. Li-Fraumeni gene? → TP53
  11. NF1 → ? → MPNST
  12. NTRK fusion drug? → Larotrectinib
  13. Bone modifying agents? → Zoledronic / denosumab / radium-223
  14. RT pain dose? → Single 8 Gy
  15. Mirels ≥ 9? → Prophylactic fixation

⚠ AI 草皿。