GU Flashcards
The ORIOLE phase 2 randomized trial compared SBRT to observation in patients with oligometastatic prostate cancer. What outcome was increased in the SBRT arm?
A. OS
B. Grade 3 - 4 toxicity
C. PFS
D. ctDNA concentration
C. PFS
Treating the sites of oligometastasis with SBRT lead to improved progression free survival and distant metastasis free survival.
What is the 5-year OS for MIBC treated with chemoRT?
A. 15 - 20%
B. 45 - 50%
C. 60 - 65%
D. 80 - 85%
B. 45 - 50%
In a Phase 3 randomized trial comparing chemoradiation to radiation alone, the group of patients receiving chemoradiation had a 5-year OS rate of 48%.
James ND, Hussain SA, Hall E, et al. Radiotherapy with or without chemotherapy in muscle- invasive bladder cancer. N Engl J Med 2012; 366: 1477-88.
In otherwise healthy patients with MIBC receiving chemoRT, which is an appropriate radiosensitizing chemotherapy regimen?
A. Cisplatin and pemetrexed
B. Carboplatin and paclitaxel
C. Cisplatin and etoposide
D. 5-FU and mitomycin
D. 5-FU and mitomycin
A phase III randomized trial showing the efficacy of chemoradiation for bladder cancer used concurrent 5FU and mitomycin as a radiosensitizer.
James ND, Hussain SA, Hall E, et al. Radiotherapy with or without chemotherapy in muscle- invasive bladder cancer. N Engl J Med 2012; 366: 1477-88.
What is a preferred surgical treatment paradigm for patients with resectable urothelial MIBC and good renal function?
A. Neoadjuvant pembrolizumab followed by radical cystectomy
B. Radical cystectomy followed by adjuvant cisplatin/gemcitabine
C. Radical cystectomy followed by adjuvant pembrolizumab
D. Neoadjuvant cisplatin/gemcitabine followed by radical cystectomy
D. Neoadjuvant cisplatin/gemcitabine followed by radical cystectomy
Neoadjuvant cisplatin-based chemotherapy is preferred and based on a higher level of evidence compared to adjuvant cisplatin-based chemotherapy. Immunotherapy does not yet have a defined role in the non-metastatic setting.
What is the 4-year local control rate after SBRT for primary renal cell carcinoma?
A. 60 – 70%
B. 71 - 80%
C. 81 – 90%
D. 91% - 100%
D. 91% - 100%
In an international analysis of 223 patients, the 4-year rate of local control, cancer-specific survival, and progression-free survival were 97.8%, 91.9%, and 65.4%, respectively.
What is the predominant pattern of failure in patients with MIBC ≥ pT3 status post radical cystectomy with negative margins?
A. Inguinal lymph nodes
B. Presacral nodes
C. Cystectomy bed
D. Iliac/obturator nodes
D. Iliac/obturator nodes
Based on a large series of patients who had undergone radical cystectomy for urothelial bladder cancer, Baumann et al. found that the predominant site of failure was the iliac/obturator nodes for patients with negative margins and for patients with positive margins, the predominant pattern of failure is the cystectomy bed and presacral nodes.
Which single feature would make a patient’s prostate cancer Unfavorable Intermediate Risk Group?
A. PSA > 10
B. T2a
C. Grade Group 2
D. Grade Group 3
D. Grade Group 3
In the widely used prostate risk stratification criteria adapted by the NCCN that originated from the Zumsteg et. al. 2013 publication showed GG3, >50% core positivity and >1 intermediate risk factors as the three populations that have worse prognosis in the intermediate risk category of prostate cancer.
What is the lowest risk-group of prostate cancer where a metastatic workup with a bone scan may be recommended?
A. Low risk
B. Favorable Intermediate
C. Unfavorable Intermediate
D. High risk
C. Unfavorable Intermediate
The probability of bone metastasis becomes relevant at unfavorable intermediate risk and higher risk groups of prostate cancer.
For stage I seminoma treated with orchiectomy alone and no adjuvant treatment, what are the 15-year relapse and salvage rates respectively?
A. 20% and 100%
B. 30% and 100%
C. 20% and 80%
D. 30% and 90%
A. 20% and 100%
The risk-adapted management approach of testicular seminoma is based on low rates of 15 year relapse of about 20% and a very high rate of cure for those who relapse.
A 65 year-old male diagnosed with MIBC decided to proceed with bladder preservation as his treatment choice. Given no other comorbidities, normal tolerance doses and concurrent chemotherapy, what total bladder radiation dose in 1.8 - 2.0Gy/fx is appropriate?
A. 50 Gy
B. 55 Gy
C. 64 Gy
D. 74 Gy
C. 64 Gy
64 Gy in conventional fractionation is the appropriate standard regimen for bladder preservation in the setting of concurrent chemotherapy.
A 68 year-old male presents with favorable intermediate risk prostate cancer and elects to receive low dose rate brachytherapy alone. Which is an appropriate isotope and dose prescription?
A. 125Iodine and 115 Gy
B. 125Iodine and 145 Gy
C. 103Palladium and 85 Gy
D. 103Palladium and 100 Gy
B. 125Iodine and 145 Gy
The appropriate low dose rate brachytherapy prescription for monotherapy is 145 Gy with Iodine-125 and 125 Gy with Palladium-103.
A 73 year-old male is diagnosed with prostate cancer and his staging workup reveals 6 bone metastases on his bone scan. Which of the following is considered a category 1 treatment recommendation per the NCCN?
A. Abiraterone and prednisone with ADT
B. RT to the prostate with ADT
C. RT to the prostate and SBRT to the bone metastases with ADT
D. Pembrolizumab with ADT
A. Abiraterone and prednisone with ADT
This patient presents with high volume metastatic disease. Two phase 3 studies have shown abiraterone with androgen depravation therapy is associated with improved survival compared to androgen deprivation therapy alone. Per the NCCN, radiation therapy to the prostate should not be routinely performed in patients with high volume metastatic disease and this is based on two randomized trials, the HORRAD and STAMPEDE studies.
In a patient with bladder cancer, which is a CONTRAINDICATION to a bladder preservation strategy with definitive chemoRT?
A. Any tumor with bilateral hydronephrosis
B. T3 disease
C. T2 disease
D. 4 cm tumor in the right lateral wall
A. Any tumor with bilateral hydronephrosis
Definitive chemoradiation for bladder cancer is most successful for patients without tumor associated hydronephrosis and without extensive carcinoma in situ.
In a patient undergoing RT for stage IIB seminoma with gross nodal disease, what dose and treatment method are recommended?
A. 20 Gy with AP/PA fields
B. 20 Gy using IMRT
C. 36 Gy with AP/PA fields
D. 36 Gy using IMRT
C. 36 Gy with AP/PA fields
The standard dose for IIB seminoma is 36 Gy. Mean dose to kidneys, liver and bowel are lower with CT based AP/PA three-dimensional conformal radiation therapy than intensity modulated radiation therapy. As a result, the risk of second cancers may be lower with an AP/PA beam arrangement than with intensity modulated radiation therapy.
What is the inferior border of the prostate bed RT volume with respect to the vesiculourethral anastomosis (VUA)?
A. At the VUA
B. 1-5 mm below the VUA
C. 8-12 mm below the VUA
D. 16-20 mm below the VUA
C. 8-12 mm below the VUA
The prostate bed has the following boundaries:
- anterior: posterior edge of pubic bone, or posterior 1-2 cm of bladder wall (when above superior edge of pubic symphysis)
- posterior: anterior rectal wall, or mesorectal fascia (when above superior edge of pubic symphysis)
- lateral: levator ani muscles, obturator internal, sacrorectogenitopubic fascia
- inferior: 8-12 mm below the vesiculourethral anastomosis
