inservice rando knowledge Flashcards
what are adjuvant RT regimens for skin cancer?
50Gy/20fxs 60Gy/30fxs
on GOG 33, what was the risk of pelvic lymph node involvement for grade 1 tumors involving the inner third vs. outer third of the myometrium?
3% vs. 11%
what is the most common histology for male urethral cancers?
squamous cell (80%)
what are the doses for neuroblastoma status post GTR and for gross residual tumor
21.6Gy if GTR 36Gy if gross residual
what are the IPI criteria for advanced stage Hodgkin lymphoma?
ALL SHAM Age > 45 Leukocytosis > 15 Lymphopenia Stage IV Hgb < 10.5 Albumin < 4 Male
Per NCCN, what total dose of RT is recommended with concurrent chemo for Ib2 cervical cancer?
>85Gy
what is the recommended dose for ALL patients who have persistent testicular disease after induction chemo?
24Gy
What is the MOST appropriate treatment of a 55-year-old patient with diffuse superficial transitional cell carcinoma of the bladder that has recurred after transurethral resection of the bladder tumor (TURBT) and intravesical BCG?
cystectomy
what constitutes T3b renal cell carcinoma?
tumor extending into vena cava below the diaphragm (does not invade wall of vena cava cuz that’s T3c)
what is the MOA of exemestane?
steroidal aromatase inhibitor
what translocation is associated with resistance to H. pylori eradication in gastric MALT?
t(11;18)
According to the 7th edition AJCC staging manual, penile cancer involving bilateral inguinal lymph nodes is staged as:
N2 (multiple ipsilateral nodes or bilateral nodes)
what criteria are used to define active/symptomatic myeloma?
CRABC - elevated calciumR - renal insufficiencyA - anemiaB - bone lesions
test for continuous independent variable and continuous dependent variable
regression
What was the involved field radiation therapy dose in Gy used for nodal sites in complete response in EORTC trial 20884 (Aleman et. al. New England Journal of Medicine, 2003) in patients with stage III or IV Hodgkin lymphoma after MOPP-ABV
24Gy
what is the expansion for APBI with interstitial and intracavitary/balloon brachytherapy?
interstitial - 1.5cm intracavitary - 1cm
what is the CTV expansion and dose for APBI using EBRT?
1.5cm, 38.5Gy (+1cm for PTV)
risk factors for CNS involvement in ALL
mature B-cell immunophenotypeT-cell immunophenotypehigh LOH
What is the expected 2-year locoregional freedom from progression (FFP) rate following IMRT–based chemoRT for nasopharyngeal carcinoma?
90%
what chemo is used up front for T-cell ALL
intrathecal MTX
After complete resection for locally advanced rectal cancer, the MOST common site for local recurrence is the:
presacral space
what constitutes RPA class 1 and class 3?
class 1 - KPS>70+, age <65 class 3 - KPS<70
what is the preferred doublet chemotherapy for unresectable mesothelioma?
cisplatin / pemetrexed (40% response rate)
what RT dose causes ovarian failure in a 30 year old?
14Gy for 30yo(18-20Gy from birth to 10yrs)
what constitutes M1 cutaneous T-cell lymphoma?
visceral involvement
in the EORTC trial of PCI for patients with ES-SCLC, what was the risk of brain mets at 1 year with and without PCI?
15% vs. 40%, survival improved from 12 weeks to 14.7 weeks
The BC2001 (James et. al., NEJM 2012) study was a phase III trial that randomized patients with muscle invasive bladder cancer between chemoradiotherapy versus radiotherapy alone. What is the locoregional disease free survival at 2 years in patients who underwent chemoradiotherapy?
67%
MOA for nivolumab, pembrolizumab, and ipilimumab
nivolumab: anti-PD-1 antibody pembrolizumab: anti-PD-L1 antibody ipilimumab: CTLA-4 antibody
what is the histologic feature of retinoblastoma?
Flexner-Wintersteiner rosettes
criteria for stage III Wilms
BSSLURPP: Biopsy Spillage Subtotal resection Lymph nodes Unresectable Rupture Peritoneal implants Piecemeal resection
what is the treatment paradigm for high risk neuroblastoma?
Induction: induction chemotherapy followed by primary tumor resection Consolidation: myeloablative chemotherapy with autologous stem cell transplant and consolidative radiation Post-consolidation: immunotherapy and cytokines plus isotretinoin.
What criteria constitute International Prognostic Factors for advanced Hodgkin lymphoma?
Stage IV, male sex, age >45serum albumin <4 g/dl, hemoglobin <10.5 g/dl, lymphocyte count <600/mm3
What CSF tumor marker levels are consistent with non-metastatic CNS pure germinoma?
normal AFT, normal or slightly elevated bHCG (<50)
The yield of PET/CT scan in detecting a primary cancer for patients presenting with cervical lymph node metastasis of unknown origin has been shown to be approximately:
30% per DAHANCA 13
Following RT for a solitary plasmacytoma, how often is skeletal survey obtained?
skeletal survey every 9-12 months
what are the 4 subsites of the nasal cavity?
septum, floor, lateral wall, vestibule
what are the 5 sections of the male urethra?
glandular, penile, bulbous, membranous, prostatic(anterior urethra - glandular/penile/bulbous)(posterior urethra - membranous/prostatic)
what dose rates define HDR and LDR brachytherapy?
LDR 0.4-2Gy/hrHDR >12Gy/hr
what is the rate of distant failure for surgically resected gallbladder cancer vs. hilar cholangiocarcinoma vs. intrahepatic cholangiocarcinoma?
gallbladder - 85% hilar cholangio - 40% intrahepatic cholangio - 25%
The risk of vaginal recurrence at 5 years for patients randomized to vaginal brachytherapy in PORTEC-2 (Nout) was:
1.8% for brachy, 1.6% for EBRT
what 2 mutations are common in follicular lymphoma?
t(14;18) and BCL2
what was the surgery and adjuvant chemotherapy used in the CLASSIC trial?
D2 gastrectomyadjuvant oxaliplatin/capecitabine
What was the strongest predictor for local recurrence for DCIS treated by excision without radiation on the ECOG E5194 study at 5 years?
grade
what is the RT dose for MALT (gastric and orbit)?
30Gy/15fxs
What is an appropriate radiation dose for a 15-year-old boy with stage IIB Hodgkin lymphoma of the neck and mediastinum without bulky disease is to be treated with involved-field radiation therapy after a complete response to four cycles of chemotherapy?
21Gy
How many cases of SCLC are diagnosed annually in the US and what percentage of patients present with extensive stage disease?
35,000 65% present with extensive stage disease PET results in upstaging in 8%
What is the MOST appropriate dose in Gy for PCI in a 10-year-old boy with high risk acute lymphoblastic leukemia (ALL) and no evidence of central nervous system involvement?
18Gy (current protocol uses 12Gy so be wary) Current protocol AALL0434: Int and high risk: 12 Gy in 1.5 Gy per fx CNS 3: 18 Gy in 1.8 Gy per fx CNS1-2, low risk: no RT (get prednisone) residual testicular disease after chemo: 24 Gy CN3 with overt cranial nerve involvement, symptoms: give 24 Gy upfront before chemo
what were the inclusion criteria for SWOG 8794 (prostatectomy +/- adjuvant RT)?
SVI, ECE, positive margin
what is the T stage for NSCLC with visceral pleural invasion?
T2a
What ratio of positive ipsilateral groin nodes to total resected predicts contralateral groin metastasis in vulvar cancer?
20%
what IHC stains help distinguish mesothelioma from adenocarcinoma NSCLC?
calretinin, thrombomodulin
what is the typical dose for paraganglioma? what is the local control rate with definitive radiation?
45Gy, 90%
what vertebral bodies correspond with the approximate levels of the celiac axis, SMA, and IMA?
celiac - T12SMA - L1IMA - L3
What chromosomal deletion in a patient with chronic lymphocytic leukemia is associated with an unfavorable prognosis?
17p
what is the N stage for renal cell carcinoma with 6 positive lymph nodes?
N1 (there is no N2)
Approximately what percentage of penile cancer is positive for HPV DNA?
80%
what T stage is a renal cell carcinoma that extends beyond Gerota’s fascia?
T4
On the Intergroup Rhabdomyosarcoma Study IV, the 3 year FFS of patients with metastatic embryonal rhabdomyosarcoma involving 2 or fewer metastatic sites was:
40% for embryonal <3 sites 25% for embryonal 3+ sites 20% for non-embryonal <3 sites 5% for non-embryonal 3+ sites
what constitutes T2 cholangiocarcinoma of the distal bile duct?
invasion beyond the wall of the bile duct
On ECOG 5194 (DCIS +/- RT), what 2 factors indicated a higher risk of ipsilateral breast event?
nuclear grade, patient age
what is the histologic feature of medulloblastoma?
Homer-Wright rosettes
What is the overall objective response rate to FOLFIRINOX (5-FU, oxaliplatin, leucovorin, and irinotecan) for patients with metastatic pancreatic cancer?
30% survival 11mo vs 6mo with gem alone for stage IV pts
The randomized trial by EORTC and RTOG comparing standard PCI dose to higher-dose in patients with limited-stage SCLC showed the higher dose of PCI:
resulted in worse survival and no difference in incidence of brain metastases
what are the criteria for age adjusted IPI?
PLS performance status 2+ LDH elevated stage 3-4
What is the 5yr OS for WNT and SHH medulloblastoma?
WNT 95% SHH 75%
following bladder preservation treatment, what percentage of long-term survivors will maintain an intact bladder?
80%
test for categorical independent variable and categorical dependent variable
chi square
What percent of patients with an urothelial carcinoma of the renal pelvis will have an urothelial carcinoma of the bladder?
50%
what are the indications for adjuvant radiotherapy for vulvar cancer?
close margins (<8mm) LVSI DOI >9mm
what are the adjuvant chemo options for patients with pN2 NSGCT?
BEP x 2 cycles or EP x 2 cycles
what chemo showed OS benefit when added adjuvantly to treatment of STS?
doxorubicin/ifosfamide (Pervais meta analysis)
what is the most likely diagnosis for a boy with a pineal mass and CSF with elevated bHCG and undetectable AFP?
pure germinoma, biopsy not required
what CT phase should be used for treatment planning when treating liver mets or intra-hepatic cholangiocarcinoma?
portal venous phase
what percentage of RT plans on Z11 utilized high tangents?
50%
factors included in IPI for non-Hodgkins
Age, Performance status, LDH, Extranodal sites, Stage
What dose and fractionation should be used for palliative splenic RT for CLL?
0.25-1 Gy fractions delivered daily or 2-3 times per week to a total dose of 4-10 Gy
What was the complete pathologic response in GOG 201 a Phase 2 study of concurrent weekly cisplatin and radiation in advanced carcinoma of the vulva?
50%
what is the risk of radiographic multi-focal disease at presentation for the following patients with primary CNS lymphoma: immunocompetent immunocompromised AIDS-related
immunocompetent - 40% immunocompromised - 70% AIDS-related - 95% (almost all patients have pathological multifocal disease if examined microscopically)
on subgroup analysis of intermediate risk patients on RTOG 9408, what was the 10yr OS improvement with addition of short term ADT?
10yr OS improved by 7% (61% vs. 54%)
what constitutes B1 cutaneous T-cell lymphoma?
circulating sezary cells >5% of lymphocytes and <1000 sezary cells/uL
What are the systemic therapy options for desmoid tumors?
NSAIDs (sulindac or celecoxib), hormonal or biological agents (tamoxifen, toremifene, or low-dose interferon), chemotherapy (methotrexate and vinblastine, doxorubicin-based regimens), and TKIs (imatinib and sorafenib)
what is the risk of secondary cancers in pediatric cancer survivors at age 30?
20% including non-melanoma skin cancer 8% excluding non-melanoma skin cancer
what is the treatment paradigm for osteosarcoma?
neoadjuvant chemo, surgical resection, adjuvant chemo for 4-6 months (results in long term survival of 60% vs. just 20% with surgery alone)
what is the RT dose for a supratentorial ependymoma status post GTR in a 10 month old?
54Gy (for patients under 18mo s/p GTR, all others receive 59.4Gy)
what percentage of Wilm’s tumors have calcifications on imaging?
10-15% (calcs are associated with neuroblastoma asshole)
Which tumor most commonly occurs in the anterior mediastinum of adults?
thymoma
What is the appropriate dose range for single fraction SRS to a 1.0 cm WHO gr 1 meningioma?
12-16Gy
in RTOG 9111, what endpoints were improved with concurrent CRT as compared to sequential CRT?
concurrent CRT resulted in superior laryngeal preservation, local control, and locoregional control
what is the 10 year LRR with and without PMRT for patients with stage III breast cancer who have a pCR to neoadjuvant chemotherapy (MDACC)?
10yr LRR 33% without PMRT, 7% with PMRT
What is the most common genetic aberration in rhabdoid tumors of the kidney?
deletion of chromosome 22q (INI1/hSNF5)
what is the inferior boundary of the retropharyngeal lymphatics?
cranial aspect of hyoid bone
what are the 3 most common side effects of cetuximab?
acneiform rash, hypomagnesemia, infusion reaction
what is the RT regimen for ATRT in a child younger than 3?
50.4Gy to primary site only, no CSI
what structures comprise the CTV for IMRT for IB2 cervical cancer?
GTV, cervix, entire uterus, parametrium, upper half of vagina
What was the radiation dose in Gy used in ECOG 1484 (Horning et. al. JCO, 2004) for patients with non-Hodgkin lymphoma in complete response following chemotherapy? What chemo was used?
30Gy CHOP x8
what are the absolute contraindications to breast conserving surgery
pregnancy diffuse microcalcifications persistent positive margins widespread disease that cannot be removed through a single incision with good cosmesis
what is the hallmark of double hit lymphoma?
translocations of cMYC and BCL2
What is the total recommended dose (EBRT + LDR equivalent brachytherapy) for a patient with positive vaginal margins following hysterectomy for endometrial cancer per ABS guidelines (Small 2012)?
70-80Gy
For a BRCA1 patient, what is the risk of developing ovarian cancer?
20-40% patients are also at risk for fallopian tube cancer
what hormone has the lowest threshold for dysfunction after hypothalamic/pituitary RT?
Growth hormone (only requires 18Gy)
A sentinel lymph node biopsy is positive in what proportion of patients with Ductal Carcinoma In Situ (DCIS)?
5%
what percentage of multiple myeloma is non-secretory?
3%
Following surgery for a large cell carcinoma of the left lung, pathology demonstrated a 2.5 cm primary cancer with negative margins where there were four involved level 11 lymph nodes and 1 AP window lymph node that demonstrated metastatic disease. What is the recommended treatment following surgery?
Cisplatin based doublet x 4 cycles followed by mediastinal RT
What is the appropriate sequence for the workup for an occult primary of the head and neck in a patients that presents with a neck mass and has negative flexible laryngoscopy?
FNA node, CT neck, PET/CT, EUA/tonsillectomy
where is the motor cortex?
precentral gyrus
what were the fibrosis rates on the O’Sullivan STS trial?
48% vs. 32% favoring preop
Under the new WHO (2016) grading (grade group) system for prostate cancer, a Gleason pattern of 4+3 would fall under which grade group category?
group 3
for postop endometrial cancer, what are the 3 main HDR regimens?
6Gy x 5 to surface 4Gy x 6 to surface 7Gy x 3 to 5mm depth
Following RTOG 0617, what is the recommend V30 heart constraint?
V30<50
Approximately what percent of Merkel cell cancer is due to the polyomavirus?
80%
what is the risk of pelvic lymph node involvement with stage II cervical cancer?
30% (rule of 15’s, stage x 15)
WTF is palifermin
human keratinocyte growth factor used to reduce severity of mucositis during H&N RT
On RTOG 0933 (hippocampal avoidance) what was the mean relative decline in HVLT-R DR from baseline to 4 months?
7% (compared to 30% in historical controls)
what percent of pediatric patients with Hodgkin lymphoma present with stage IV disease?
20%
What is the 5-year survival rate for patients with inflammatory breast cancer?
40%
What is the most common route of intracranial invasion in a nasopharyngeal carcinoma?
foramen lacerum
what are the biomarker profiles for luminal B breast cancer?
ER/PR+, Her2+ER/PR+, Her2-, high Ki-67
What is the FIGO stage of a 4 cm carcinoma of the vulva with 8 mm of stromal invasion confined to the right labia majora and negative lymph nodes?
IB
per quantec, what is the risk of symptomatic pneumonitis with lung V20 < 30%?
<20%
what is penile bulb D90 constraint per QUANTEC?>
D90 < 50Gy (risk of ED <35%)
Per NCCN, what are the indications for bone scan in the setting of prostate cancer?
T1 disease with PSA > 20ng/ml,T2 disease with PSA > 10 ng/ml, a Gleason score of < 8, T3 or T4 disease, or symptomatic
what is the histologic feature of medulloblastoma?
Homer-Wright rosettes
what percentage of primary CNS lymphoma patients will present with ocular involvement?
20%
The overall larynx preservation rate in the Veterans Affairs (VA) Larynx Trial was:
64%
What constitutes CNS 2 T-cell ALL?
< 5/ L WBCs and cytospin positive for blasts or ≥ 5 μL WBCs
what is rate of pain flair after single fx RT for bone mets?
35%
what is the most common site of subependymoma?
ventricular system
Per QUANTEC, what is the risk of optic neuropathy with 55-60Gy conventionally-fractionated RT to the optic nerve/chiasm?
5%
on Slotman trial for ES-SCLC, what was the benefit in median survival for patients who received PCI?
median survival 6.7mo vs. 5.4mo1yr OS 27% vs. 13%
What is the maximum dose constraint in Gy for the spinal cord when SBRT is given in 3 fractions for an early stage lung cancer?
18Gy 14Gy for 1fx, 30Gy for 5fxs
what was the treatment paradigm on the NCIC trial for cervical cancer?
WP 45 Gy + LDR 35 Gy x 1 or HDR 8 Gy x 3; weekly cisplatin during external beam
criteria for stage III multiple myeloma
hemoglobin < 8.5 orcalcium >12 orBence Jones >12g/24hr oradvanced lytic lesions
where do most ependymomas present in adults?
spine
sorry dude this is gonna suck…what were the 4 treatment arms in RTOG 9003?
standard frac: 70Gy/35fxshyperfrac: 81.6Gy/68fxs BIDaccelerated frac split course: 67.2Gy/42 BID with 2 week break in middleaccelerated frac concomitant boost: 72Gy/42fxs, BID during final 2 weeks
According to the CLASSIC trial, addition of what treatment resulted in improved disease-free survival among patients with gastric cancer?
adjuvant capecitabine and oxaliplatin
median survival on Stupp trial for patients with MGMT methylation that received temozolomide and RT
23 months
on GOG 37, what was the 2yr local recurrence rate for patients randomized to RT?
2yr LRR 5%
What is the rate of clinical radiation pneumonitis in breast cancer patients from comprehensive regional node irradiation that includes the internal mammary lymph node chain?
1%
NSABP analysis shows patients with T3N0 breast cancer treated with mastectomy, chemotherapy and no radiation have a 10-year LRR rate of:
7%
what is the standard treatment for primary mediastinal large B-cell lymphoma?
DA-EPOCH x 6 cycles (chemo alone)
what is the MOA of anastrazole and letrozole?
non-steroidal aromatase inhibitors
What is the estimated risk of fracture at 5 years for a vulvar cancer patient if the femoral neck received 50 Gy when treating the inguinal nodes?
11%
what is the group stage for T2N3 breast cancer?
IIIC
what is the preferred V20 for contralateral lung in treating with hemithoracic IMRT for mesothelioma?
V20 < 7%
What is the appropriate stage grouping (AJCC, 7th Ed) for a patient status post R0 resection of a 12 cm high grade sarcoma of the anterior compartment of the thigh?
stage III; pT2b cN0M0 G3
what is the adjuvant RT dose for hemangiopericytoma status post GTR?
55-60Gy
