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33 Cards in this Set
- Front
- Back
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141. Which of the following statements about heterotrophic ossification is true? |
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144. Which of the following sites of pathologic bone fracture occurs most commonly secondary to metastatic cancer, regardless of the primary tumor site? A. Humerus B. Acetabulum C. Femoral shaft D. Subtrochanteric femur |
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163. Which of the following radiation fractionation schedules used to treat bone metastases provides the highest biological effective dose (BED) for symptomatic relief? A. 08 Gy in 1 fraction B. 20 Gy in 5 fractions C. 30 Gy in 10 fractions D. 40.5 Gy in 15 fractions |
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88. Which of the following clinical descriptions is associated with grade III heterotrophic bone formation? A. Bony islands within the soft tissues around the hip B. Bony ankylosis between the proximal femur and pelvis C. Exophytes of the pelvis or proximal femur and a distance of at least 1 cm or more D. Exophytes of the pelvis or proximal femur and a distance of less than 1 cm |
Correct answer is D. RATIONALE: Option A: Grade II. Option B: Grade IV. Option C: Grade II. Option D: Grade III. REFERENCES: Booker AF, Bowerman JW, Robinson RA, Riley CH: Ectopic ossification following total hip replacement. Journal of Bone Joint Surgery. 1973;55:1629-1632. Gunderson & Tepper, eds. Clinical Radiation Oncology. 2nd edition. 2007;1561-1562. |
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228. What is the MOST appropriate management strategy for thymomas? (A) Postoperative radiotherapy is indicated for fully resected, well-encapsulated thymomas. (B) Postoperative radiotherapy may not be needed for fully resected stage II thymomas. (C) There is currently no established role for adjuvant chemotherapy. (D) At least 60 Gy is recommended after R0 resection. |
Key: B Rationale: Choice A is incorrect since fully resected stage I thymomas do not need postoperative RT. Choice C is incorrect since chemotherapy is an important component in the management of thymomas. Choice D is incorrect since the recommended postoperative dose for R0 resected thymomas is 45-50 Gy. Choice B is correct because the most recent surgical series suggest that postoperative radiotherapy may be omitted for fully resected stage II thymomas. |
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118. Which of the following statements about the response rate to radionuclide therapy for painful metastatic bone disease is true? A. The partial response rate for strontium is 50% to 60%. B. The complete response rate for strontium is 30% to 50%. C. The partial response rate for samarium is 40% to 50%. D. The complete response rate for samarium is 50% to 55%. |
Correct answer is D. RATIONALE: Radionuclide Partial Rate Complete Rate Response Duration 89Sr 65 – 80% 10 – 30% ~6 mos. Samarium 75 – 80% 54% 2 – 4 ½ mos. REFERENCE: Gunderson & Tepper, eds. Clinical Radiation Oncology. 2nd edition. 2007;448. |
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287. Which of the following pharmaceutical treatments is most appropriate for preventing heterotopic ossification after orthopedic surgery? A. Alendronate B. Indomethacin C. Prednisone D. Vitamin D |
Correct answer is B. RATIONALE: Indomethacin has been shown in several trials to have efficacy for prevention of heterotopic ossification after orthopedic surgery. |
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93. According to randomized data from RTOG 74-02 (Tong), which of the following statements about fractionation schedules for treating bone metastases is true? A. Greater toxicity occurred with higher total doses and more fractions. B. Faster pain relief was achieved with higher total doses and more fractions. C. Multiple-fraction regimens were associated with worse patient compliance. D. There was no statistically significant difference in pain relief for the fractionation schemes tested. |
Correct answer is D. RATIONALE: The initial publication of Radiation Therapy Oncology Group (RTOG) 74-02 showed no difference in fractionation schedules. |
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115. Which of the following statements about liver tolerance to radiation therapy is true? A. Whole-liver tolerance is approximately 30 Gy in 3-Gy fractions. B. One third of the liver can be treated safely with radiation doses up to 90 Gy. C. Patients with metastatic liver disease have a lower liver tolerance than those with primary liver tumors. D. The pathological hallmark of radiation-induced liver disease is sclerosis of the portal triad. |
Correct answer is B. RATIONALE: Whole-liver tolerance is approximately 30 Gy in 2-Gy fractions. Patients with metastatic liver disease have a higher tolerance than those with primary liver tumors. The pathological hallmark of radiation-induced liver disease is venoocclusive disease. |
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129. Which of the following statements about the use of radiation therapy to prevent heterotopic ossification is true? A. Doses of >10 Gy should be used in single-fraction regimens. B. Preoperative treatment is superior to postoperative treatment. C. Postoperative radiation therapy should begin within 72 hours of surgery. D. Multiple-fraction regimens have been shown to be superior to single-fraction regimens. |
Correct answer is C. RATIONALE: Randomized studies demonstrate similar or perhaps improved efficacy with postoperative radiation therapy to prevent heterotopic ossification. |
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18. Which of the following findings is most characteristic of Langerhans cell histiocytosis? A. Psammoma body B. Physaliphorous cell C. Homer-Wright rosette D. Birbeck granule |
Correct answer is D. RATIONALE: Birbeck granules are characteristic of Langerhans cell histiocytosis (LCH) and can be seen on electron microscopy. Psammoma bodies are collections of calcium seen in a variety of different neoplasms; physaliphorous cells are seen with chordoma; Homer-Wright rosettes are typically seen with neuroblastoma. |
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34. What is the MOST appropriate therapy for persistent disease after definitive radiation therapy for a solitary extraosseous plasmacytomas? (A) Surgery (B) Cryotherapy (C) Brachytherapy (D) Radio-frequency ablation |
Key: A Rationale: Extraosseous plasmacytoma can be cured with multimodality treatment. Surgery may have a role in the treatment of extraosseous plasmacytoma. References: NCCN MM Guidelines MS-4. |
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35. Which variant of well-differentiated thyroid cancer has the worst prognosis? (A) Follicular carcinoma (B) Hurthle cell carcinoma (C) Papillary carcinoma (D) Papillary carcinoma with euploid DNA |
Key: B References: Cady et al. Surgery. 1988 Dec; 104(6):947-53. Sherman SI, Cancer. 1998 Sep 1; 83(5):1012-21. |
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77. Which of the following statements about the use of hemibody radiation therapy for palliation of bone metastases is true? A. This approach typically involves doses of 30 Gy. B. Blood cell counts do not need to be monitored after its administration. C. This type of therapy is best used for patients with only one or two metastatic lesions. D. The onset of pain relief is more rapid than with small-field regimens. |
Correct answer is D. RATIONALE: The onset of pain relief is more rapid (often within 48 hours) for small-field regimens of hemibody radiation therapy for palliation of bone metastasis. |
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267. Which of the following tissues is hypointense on a T2 weighted MR image? (A) Edema (B) White matter (C) Compact bone (D) Cranospinal fluid |
Key: C Rationale: Compact bone has the shortest T2 signal of the tissues listed, which will appear hypointense (dark) in a T2 weighted MR image. Unlike the others, compact bone is a solid. In a solid, molecules are closely packed, thus more protons interact (the greater the spin-spin interactions compared to a liquid) and the quicker the T2 signal decays. The T2 relaxation times for the remaining tissues increase in the following order: white matter (77 msec, 1.5 T), edema (125 msec, 1.5 T), and CSF (180 msec, 1.5 T). References: Hashemi, R.H et al., MRI the basics, 2nd Edition, Lippencott, Williams & Wilkins, Copyright 2004. |
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342. What is the typical single fraction hemibody dose that is used to treat bone metastasis? A. 04 Gy B. 06 Gy C. 10 Gy D. 30 Gy |
Correct answer is B. RATIONALE: Single doses of 6 Gy or 8 Gy have been used to treat the hemibody for palliation of skeletal metastases. |
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358. Which of the following processes is NOT commonly involved in the development of bone metastases? A. Avascular necrosis B. Activation of osteoclasts C. Cell adhesion molecules D. Chemotaxis of metastatic cancer cells |
Correct answer is A. RATIONALE: Avascular necrosis is not typically involved in bone metastases. |
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62. Which prognostic factor is the MOST important predictor of clinical outcomes for patients with well-differentiated papillary carcinoma of the thyroid? (A) Age at the diagnosis (B) Extranodal extension (C) Extrathyroidal extension (D) Cervical lymph node >5 cm |
Key: A References: Cady et al. Surgery. 1988 Dec; 104(6):947-53. |
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224. When Langerhans cell histiocytosis involves only a single organ, the most common single organ involved is the: (A) bone. (B) liver. (C) lung. (D) pituitary. |
Key: A References: Cancer Treat Rev. 2010 Jun; 36(4):354-9. Epub 2010 Feb 25. Langerhans cell histiocytosis: Current concepts and treatments. Abla O, Egeler RM, Weitzman S. |
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59. Nonsecretory myeloma is associated with: (A) elevated UPEP levels. (B) nonexistent urine protein levels only. (C) nonexistent serum protein levels only. (D) nonexistent serum and urine protein levels. |
Key: D Rationale: Understand that 3% of MM produces no protein products. Nonsecretory MM has nonexistent serum and urine proteins levels. References: NCCN MM Guidelines MS-2. |
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21. A relatively specific marker of Langerhans cell histiocytosis is: (A) CD1a. (B) Myogenin. (C) CD99 (MIC2). (D) Neuron specific enolase (NSE). |
Key: A References: Br J Haematol. 2012 Jan; 156(2):163-72. doi: 10.1111/j.1365-2141.2011.08915.x. Epub 2011 Oct 24. Recent advances in the understanding of Langerhans cell histiocytosis. Badalian-Very G, Vergilio JA, Degar BA, Rodriguez-Galindo C, Rollins BJ. |
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286. The BEST way to track response to treatment of myeloma patients is to follow the: (A) ESR. (B) LDH. (C) IgG levels. (D) M-protein. |
Key: D Rationale: Understand the significance of M-protein. Measuring M-protein is the best way to assess multiple myeloma. References: NCCN MM Guidelines MS-2. |
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290. Tumor lysis syndrome (TLS) is BEST managed with: (A) calcium. (B) hydration. (C) hypothermia. (D) magnesium. |
Key: B Rationale: General knowledge of complications arising from the treatment of leukemias and lymphomas with chemotherapy. The foundation of TLS management is hydration. References: NCCN NHL Guidelines MS-15. |
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96. What isotope is commonly utilized to treat pterygium? (A) 90Sr (B) 89Sr (C) 32P (D) 192Ir |
Key: A Rationale: 90Sr is commonly utilized to treat pterygium with contact therapy. This beta emitter should be distinguished from 89Sr, which is utilized as an intravenous radiopharmaceutical for bone metastases. |
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115. Which of the following is TRUE about phase II cancer trials? (A) They should be non-randomized. (B) They should include a control group. (C) They are expected to provide definitive results about a treatment. (D) They should be conducted after the maximum tolerated dose is determined. |
Key: D Rationale: The correct answer is D since phase II studies are designed to follow dose ranging phase I studies that determine the maximum tolerated dose. |
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121. A 55-year-old male with long standing history of metastatic renal cell carcinoma presents with chest pain and is found to have a 3 cm rib-based metastasis involving the posteriolateral 6th right rib evidenced on CT and bone scan. His pain is an 8/10 on the Wong-Baker FACES pain rating scale. Which of the following is MOST LIKELY to offer effective, timely pain relief? (A) 18 Gy in 3 fractions (BED = 33, α / β of 7) with SBRT (B) 24 Gy in 3 fractions (BED = 51, α / β of 7) with SBRT (C) 30 Gy in 5 fractions (BED = 56, α / β of 7) with SBRT (D) 40 Gy in 5 fractions (BED = 86, α / β of 7) with SBRT |
Key: D Rationale: The data suggest a dose-response with regards to time to symptom resolution, with a benefit seen at a BED of >85 Gy (assuming an α / β of 7). The only option with a BED > 85 is D. References: Jhaveri PM, Teh BS, Paulino AC, Blanco AI, Lo SS, Butler EB, Amato RJ. A dose-response relationship for time to bone pain resolution after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC) bony metastases. Acta Oncol. 2012 May; 51(5):584-8. Epub 2012 Jan 17. |
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134. What is the most common radiation dose for Graves ophthalmopathy? (A) 10 Gy (B) 20 Gy (C) 30 Gy (D) 40 Gy |
Key: B Rationale: Although utilized for many years, there is considerable debate regarding the timing of orbital RT in the management of Graves opthalmopathy. The most common regimen is 20 Gy in 10 fractions but lower doses may be efficacious. References: Int. J. Radiation Oncology Biol. Phys., Vol. 82, No. 1, pp. 117–123, 2012. |
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234. Which of the following is the MOST important prognostic factor for thymic malignancies? (A) Presence of myasthenia gravis (B) Extent of surgical resection (C) Addition of postoperative radiotherapy (D) Addition of postoperative chemotherapy |
Key: B Rationale: Choice A is incorrect because myasthenia gravis is not a prognostic factor but an associated paraneoplastic disorder. The additional of radiotherapy improves local control but no convincing evidence that it may improve overall survival. The addition of chemotherapy is an important component in the management of thymic malignancies, but it is less important as compared to the extent of surgical resection. Outcomes are fully dependent on the extent and completeness of resection, regardless of stage or histology. |
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144. Active multiple myeloma is BEST imaged by a: (A) PET scan. (B) bone scan. (C) gallium scan. (D) lymphangiogram. |
Key: A Rationale: Recognize that PET scan has a role in evaluating MM. PET scan is superior to these other imaging studies in active MM. References: NCCN MM Guidelines MS-3. |
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99. Compared to normal vasculature, tumor vasculature is: (A) porous and leaky. (B) less tortuous. (C) spaced at regular intervals. (D) resistant to ionizing radiation. |
Key: A Rationale: Tumor vasculature has many unique characteristics when compared to normal vasculature, including, among others, large pores and poorly organized, leaky structures. It is also more tortuous and spaced irregularly through the tumor. References: Jain RK. Normalization of tumor vasculature: an emerging concept in antiangiogenic therapy. Science 2005; 307:58-62. |
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162. What dose in Gy is used to treat solitary plasmacytomas? (A) 10-30 (B) 31-35 (C) 36-44 (D) >45 |
Key: D Rationale: General idea of the dose to treat Solitary plasmacytoma as it differs from MM. Solitary plasmacytoma should be treated >45 Gy. References: NCCN MM Guidelines MS-4. |
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274. A 69-year-old male is diagnosed with a left-sided kidney tumor and five lung metastases, one in each lobe of the right and left lung. The patient undergoes a nephrectomy and stereotactic body radiosurgery (15 Gy x 2) of two of the largest lesions in the lungs. Three months later, the three untreated lesions show a partial response. This may be an example of: (A) radiation fibrosis. (B) an abscopal effect. (C) a radiation recall reaction. (D) the inverse dose-rate effect. |
Key: B Rationale: This is a potential example of an abscopal effect. An abscopal effect is when a local therapy, such as radiosurgery, has a systemic effect, i.e., a distant bystander effect. This phenomenon that has been rarely described in renal cell carcinoma primarily after hypofractionated radiotherapy.1,2 The mechanism is not well understood, but appears to be dose dependent and may be immune mediated or mediated by anti-tumoral or anti-angiogenic substances locally produced in the irradiated volume. References: Wersäll PJ, Blomgren H, Pisa P, Lax I, Kälkner KM, Svedman C. Regression of non-irradiated metastases after extracranial stereotactic radiotherapy in metastatic renal cell carcinoma. Acta Oncol. 2006; 45(4):493-7. PubMed PMID: 16760190. Ishiyama H, Teh BS, Ren H, Chiang S, Tann A, Blanco AI, Paulino AC, Amato R. Spontaneous Regression of Thoracic Metastases While Progression of Brain Metastases After Stereotactic Radiosurgery and Stereotactic Body Radiotherapy for Metastatic Renal Cell Carcinoma: Abscopal Effect Prevented by the Blood-Brain Barrier? Clin Genitourin Cancer. 2012 Mar 10. PubMed PMID: 22409865. Camphausen K, Moses MA, Menard C, Sproull M, Beecken WD, Folkman J, et al. Radiation abscopal antitumor effect is mediated through p53. Cancer Res 2003; 63: 1990-1993 Demaria S, Ng B, Devitt ML, Babb JS, Kawashima N, Liebes L, Formenti SC. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys 2004; 58: 862-70. |
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139. According to the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0, a Grade 3 radiation dermatitis consists of: (A) moist desquamation in skin folds. (B) moist desquamation with bleeding induced by minor trauma. (C) brisk erythema with extensive dry desquamation. (D) skin necrosis. |
Key: B Rationale: Residents need to be familiar with CTCAE v4 and the characterization and scoring of typical adverse effects caused by radiation. CTCAE is increasingly replacing the more classical radiation injury scoring systems, such as RTOG, LENT and SOMA. |
