CNS Flashcards
The addition of memantine to WBRT in a placebo-controlled phase III trial yielded what outcome compared to placebo and WBRT?
A. Better intracranial control
B. Poorer intracranial control
C. Better cognitive function
D. Poorer cognitive function
C. Better cognitive function
In a placebo-controlled phase III trial evaluating the role of memantine in patients receiving WBRT, Brown and colleagues reported that memantine use resulted in better preservation of cognitive function. This established memantine as standard of care for patients receiving WBRT with a better prognosis.
What was the impact of hippocampal avoidance WBRT plus memantine compared to conventional WBRT plus memantine in a phase III trial?
A. No benefit over conventional WBRT
B. Improved neurocognitive function but worse intracranial tumor control
C. No benefit for neurocognitive function but improved patient-reported symptoms
D. Improved neurocognitive function and improved patient-reported symptoms
D. Improved neurocognitive function and improved patient-reported symptoms
In NRG-CC001, neurocognitive failure was significantly lower in patients receiving HA-WBRT plus memantine versus WBRT plus memantine (HR 0.74, 95% CI 058-0.95, p=0.02) and patients reported less fatigue, less difficulty remembering things, and less difficulty speaking with overall fewer cognitive symptoms. There was no difference in OS, intracranial PFS, or toxicity.
What is the estimated rate of cavity recurrence at 12 months in patients not receiving postoperative RT following brain metastasis resection?
A. 10 - 20%
B. 30 - 40%
C. 50 - 60%
D. 70 - 80%
C. 50 - 60%
Based on a randomized study evaluating the role of postop SRS vs. surveillance after brain metastasis resection, the 12-month freedom from local recurrence was 43% versus 72% in the SRS group (HR 0.46, 95% CI 0.24-0.88, p=0.015).
What is the BEST method for diagnosing primary intraocular lymphoma?
A. CT head with and without contrast
B. Ocular slit lamp exam
C. Extra-ocular muscle movement exam
D. PET/CT with FDG
B. Ocular slit lamp exam
Primary intraocular lymphoma (PIOL) is a form of Primary Central Nervous System Lymphoma (PCNSL). Slit lamp examination is the diagnostic procedure of choice for evaluation of possible ocular disease in patients with suspected or confirmed PCNSL. Initial signs of primary ocular lymphoma include yellowish-white infiltrates at the subretinal pigment epithelium and/or vitreous opacity. PIOL tends to involve the posterior segment of the eye, including the vitreous, choroid, or retina.
In the Collaborative Ocular Melanoma Study (COMS), an eye plaque for ocular melanoma at the most common dose of 85 Gy is prescribed to which depth?
A. 1 mm
B. 5 mm
C. 1 cm
D. 10 cm
B. 5 mm
The American Association of Physicists in Medicine (AAPM) and American Brachytherapy Society (ABS) review indicates the most commonly used prescription dose for ocular melanoma eye plaques is 85 Gy at 5 mm depth or prescribed to the tumor apex when using (125)I and (103)Pd sources.
What is the MOST likely location for primary intraocular lymphoma?
A. Posterior orbit including the vitreous, choroid, or retina
B. Anterior orbit including lens, conjunctiva, or eye lids
C. Lateral orbit including lateral rectus, lacrimal gland, or conjunctiva
D. Medial orbit including the conjunctiva, superior oblique, or lens
A. Posterior orbit including the vitreous, choroid, or retina
Primary intraocular lymphoma (PIOL) is a form of Primary Central Nervous System Lymphoma (PCNSL). Slit lamp examination is the diagnostic procedure of choice for evaluation of possible ocular disease in patients with suspected or confirmed PCNSL. Initial signs of primary ocular lymphoma include yellowish-white infiltrates at the subretinal pigment epithelium and/or vitreous opacity. PIOL tends to involve the posterior segment of the eye, including the vitreous, choroid, or retina.
What was the 3-year OS on RTOG 0424 for patients with high-risk low-grade glioma treated with concurrent and adjuvant temozolomide and RT?
A. 43%
B. 60%
C. 73%
D. 90%
C. 73%
For this single-arm, phase 2 study, patients with low-grade gliomas with ≥3 risk factors (age ≥40 years, astrocytoma, bi-hemispheric tumor, size ≥6 cm, or preoperative neurologic function status >1) received RT (54 Gy in 30 fractions) with TMZ and up to 12 cycles of post-RT TMZ. The 3-year OS was 73.5% (95% confidence interval, 65.8%-81.1%), numerically superior to the 3-year OS historical control of 54% ( P < .001).
Which patient with a low-grade glioma would gain an OS benefit from treatment with RT followed by chemotherapy based on RTOG 9802?
A. 18 year-old female with gross total resection
B. 30 year-old female with gross total resection
C. 60 year-old male with subtotal resection
D. 30 year-old male with gross total resection
C. 60 year-old male with subtotal resection
RTOG 9802 randomized high risk low grade glioma patients, defined as either >40 years only or subtotal resection, to either radiation versus radiation followed by PCV. The updated analysis found both a progression free survival benefit and overall survival benefit.
Which histological variant of meningioma is classified as grade II?
A. Anaplastic
B. Papillary
C. Chordoid
D. Rhabdoid
C. Chordoid
Grade III meningioma histologies include rhabdoid, papillary, and anaplastic. Grade II meningioma histologies include clear cell, chordoid, and atypical.
What is the upper limit of mitotic figures per 10 HPF (high power fields) in defining a grade I meningioma?
A. 1
B. 3
C. 5
D. 7
B. 3
Meningiomas are graded by mitotic figures among other features. Grade I (1) meningiomas have 3 or fewer mitotic figures per 10 HPF. Grade III (3) meningiomas have 20 or more mitotic figures per 10 HPF.
What is the recommended conventionally fractionated prescription dose range for non-functioning pituitary adenomas?
A. 20 - 34 Gy
B. 35 - 44 Gy
C. 45 - 54 Gy
D. 55 - 65 Gy
C. 45 - 54 Gy
The dose range for fractionated radiation therapy for pituitary adenoma includes a minimum of 45 Gy to maximum of 54 Gy.
What imaging characteristic of glioma is MOST indicative of low grade histology?
A. Intratumoral hemorrhage
B. High relative cerebral blood volume
C. Marked mass effect
D. Lack of contrast enhancement
D. Lack of contrast enhancement
Ring enhancement, marked mass effect, intratumoral necrosis and hemorrhage, restricted diffusion and high relative cerebral blood volume are associated with higher grade gliomas.
A histological WHO grade II diffuse astrocytic glioma is found to be IDH wild-type. Which molecular criteria would suggest this glioma will follow an aggressive clinical course like glioblastoma?
A. 1p/19q codeletion
B. TERT promoter mutation
C. Lack of MGMT methylation
D. SYT gene amplification
B. TERT promoter mutation
Per c-IMPACT-NOW, histologic grade II and III IDH-wildtype diffuse astrocytic gliomas which contain high-level EGFR amplification, the combination of whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10), or TERT promoter mutations, correspond to WHO grade IV and should be referred to as diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV.
In a randomized phase III trial, the addition of which agent to standard temozolomide chemoRT and adjuvant temozolomide for GBM with methylated MGMT promoter improved OS?
A. Procarbazine
B. Lomustine
C. Bevacizumab
D. Vincristine
B. Lomustine
CeTeG/NOA–09 phase 3 trial, patients with newly diagnosed glioblastoma with methylated MGMT promoter were randomized to standard temozolomide chemoradiotherapy (75 mg/m² per day concomitant to radiotherapy followed by six courses of temozolomide 150–200 mg/m² per day on the first 5 days of the 4-week course) or to up to six courses of lomustine (100 mg/m² on day 1) plus temozolomide (100–200 mg/m² per day on days 2–6 of the 6-week course) in addition to radiotherapy. Median overall survival was improved from 31·4 months (95% CI 27·7–47·1) with temozolomide to 48·1 months (32·6 months–not assessable) with lomustine-temozolomide (hazard ratio [HR] 0·60, 95% CI 0·35–1·03; p=0·0492 for log-rank analysis).
- At what level does the thecal sac end in adults?
A. L1/L2
B. L3/L4
C. S1/S2
D. S4/S5
C. S1/S2
Rationale: The thecal sac ends at S1/S2, best seen on sagittal T2 MRI.
