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one deck Flashcards

1
Q

National Lung Screening Trial: P/D/R

A

P: age 55-74 with more than 30 pack yearsD: CXR vs. low dose CT every 3 yearsR: all cause mortality reduced by 7% with CT

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2
Q

LCSG 821 (Ginsberg): P/D/R

A

P: T1-2N0D: lobectomy vs. wedge resection (2cm margins)R: improved LC and DFS with lobectomy, trend toward improved OS

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3
Q

London metaanalysis: P/D/R

A

P: NSCLC who underwent CRTD: metaanalysis looking at pneumonitisR: V2040%: 36% grade 2 and 3.5% grade 5

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4
Q

Wash U lung pneumonitis: P/D/R

A

P: inoperable who underwent RT +/- chemoD: rates of grade 2 pneumonitisR: V20 < 22% - zero pneumonitis, V20 > 40% - 35% pneumonitis

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5
Q

PORT metaanalysis: P/D/R

A

P/D: all available clinical trials of PORT vs. surgery aloneR: inferior OS with PORT especially in early stage, but patients treated before 3DCRT

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6
Q

ANITA: P/D/R

A

P: resected stage IB-IIIAD: adjuvant chemo vs. observation, some received PORTR: N1 patients benefit from PORT if no chemo, N2 patients benefit from PORT regardless of chemo

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7
Q

What two main trials examined the utility of post-operative RT?

A
  1. PORT metaanalysis2. ANITA
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8
Q

CALGB 8433: P/D/R

A

P: locally advanced NSCLCD: RT 60Gy +/- induction cisplatin/vinblastineR: 5yr OS improved with induction chemo

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9
Q

RTOG 9804 (DCIS +/- RT) recurrence with and without RT

A

7yr LR 7% without RT and 1% with RT

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10
Q

WTF is palifermin

A

human keratinocyte growth factor used to reduce severity of mucositis during H&N RT

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11
Q

criteria for stage III multiple myeloma

A

hemoglobin < 8.5 orcalcium >12 orBence Jones >12g/24hr oradvanced lytic lesions

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12
Q

risk factors for CNS involvement in ALL

A

mature B-cell immunophenotypeT-cell immunophenotypehigh LOH

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13
Q

test for continuous independent variable and continuous dependent variable

A

regression

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14
Q

test for categorical independent variable and continuous dependent variable

A

T-test and ANOVA

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15
Q

test for categorical independent variable and categorical dependent variable

A

chi square

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16
Q

what was the benefit at 5 years with the addition of short term ADT in the D’Amico trial?

A

10% OS benefit with ADT (88% vs 78%)

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17
Q

what infection has an increased incidence during bortezomib treatment?

A

Herpes zoster

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18
Q

what criteria are used to define active/symptomatic myeloma?

A

CRABC - elevated calciumR - renal insufficiencyA - anemiaB - bone lesions

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19
Q

what was the local recurrence rate on RTOG 9704?

A

28% overall (25% with gem, 30% with 5FU)

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20
Q

what cytokine is associated with pneumonitis following lung RT?

A

TGFbeta1

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21
Q

what RT dose causes ovarian failure in a 30 year old?

A

14Gy for 30yo(18-20Gy from birth to 10yrs)

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22
Q

what is the CTV expansion and dose for APBI using EBRT?

A

1.5cm, 38.5Gy

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23
Q

what are the 5 sections of the male urethra?

A

glandular, penile, bulbous, membranous, prostatic(anterior urethra - glandular/penile/bulbous)(posterior urethra - membranous/prostatic)

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24
Q

Following RT for a solitary plasmacytoma, how often is skeletal survey obtained?

A

skeletal survey every 9-12 months

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25
Q

what is the dose per fraction when using 4 fractions of HDR brachytherapy alone for inoperable endometrial cancer (at 2cm from sources)?

A

8.5Gy per fraction at 2 cm

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26
Q

what percentage of patients with inflammatory breast cancer will present with metastatic disease?

A

25-30%

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27
Q

criteria for stage III Wilms

A

Positive marginPositive lymph nodesPeritoneal implantsPiecemeal resectionsPillagebioPsy

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28
Q

what dose rates define HDR and LDR brachytherapy?

A

LDR 0.4-2Gy/hrHDR >12Gy/hr

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29
Q

what histopathological finding and genetic abberation are associated with AT/RT?

A

negative INI-1 staining, 22q deletion

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30
Q

Burkitt lymphoma mutation

A

t(8;14)

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31
Q

what mutations portent a poor prognosis in neuroblastoma

A

n-myc amplificationLOH 1p + 11qdiploid DNAincreased telomerase activity

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32
Q

what chemotherapy was used in RTOG 9802?

A

PCV - procarbazine/lomustine/vincristine

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33
Q

median survival on Stupp trial for patients with MGMT methylation that received temozolomide and RT

A

23 months

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34
Q

factors included in IPI for non-Hodgkins

A

Age, Performance status, LDH, Extranodal sites, Stage

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35
Q

by what mechanism is EGFR expression level elevated in H and N SCCa?

A

gene amplification

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36
Q

what percentage of RT plans on Z11 utilized high tangents?

A

50%

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37
Q

On the WECARE study, what was the 10 year risk of contralateral breast cancer for BRCA1, BRCA2, and non-carrier?

A

BRCA1 - 20%BRCA2 - 16%non-carrier - 5%

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38
Q

what hormone has the lowest threshold for dysfunction after hypothalamic/pituitary RT?

A

Growth hormone (only requires 18Gy)

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39
Q

what molecular features are characteristic of pediatric anaplastic large cell lymphoma?

A

CD30 positive (100%), ALK rearrangement (90%)

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40
Q

Per QUANTEC, what is the risk of radiation pneumonitis with V20 of 30-35% and MLD of 20-23Gy?

A

20% risk of pneumonitis

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41
Q

indications for adjuvant RT following radical hysterectomy

A

two of the following:>1/3 stromal invasionLVSItumor >4cm

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42
Q

what percentage of solitary plasmacytomas arise in bone?

A

80% are osseous, 20% are extra-osseous

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43
Q

first line TKI for clear cell carcinoma of the kidney

A

sunitinib

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44
Q

reactivation of what virus occurs after liver SBRT?

A

hepatitis B (hence the reason they start antiviral treatment prior to RT)

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45
Q

what are the biomarker profiles for luminal B breast cancer?

A

ER/PR+, Her2+ER/PR+, Her2-, high Ki-67

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46
Q

which subtype of renal cell carcinoma is associated with deletion in chromosome 3p and Von Hippel Lindau disease?

A

clear cell

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47
Q

most common cancer in children <18 months of age?

A

neuroblastoma

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48
Q

what percentage of prostate cancer patients present with high risk disease?

A

25%

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49
Q

in RTOG 9111, what endpoints were improved with concurrent CRT as compared to sequential CRT?

A

concurrent CRT resulted in superior laryngeal preservation, local control, and locoregional control

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50
Q

for prostate SBRT, what rectal wall constraints are associated with risk of grade 3+ toxicity?

A

V50 < 3cc, less than 35% of the circumference receiving 39Gy

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51
Q

what was the path CR rate in NSABP R03 comparing preop vs. postop CRT for rectal cancer?

A

path CR rate 15% (obviously only in preop group)

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52
Q

on PORTEC-1, what was the 3 year OS after salvage radiation for patients who relapsed at the vaginal cuff following observation?

A

3yr OS 73%

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53
Q

what is the Siewert classification of a tumor mass centered in the gastric cardia with extension of the gastroesophageal junction?

A

Siewert type III

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54
Q

what constitutes T3 gallblader cancer?

A

invasion of visceral peritoneum, liver, or ONE adjacent organ

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55
Q

what is the N stage for anal cancer with unilateral pelvic side wall and inguinal lymph nodes?

A

N2

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56
Q

what is the recommended dose for ALL patients who have persistent testicular disease after induction chemo?

A

24Gy

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57
Q

what is the most common testicular cancer in men older than 50?

A

lymphoma

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58
Q

what are the 3 most common side effects of cetuximab?

A

acneiform rash, hypomagnesemia, infusion reaction

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59
Q

based on the EBCTCG meta-analysis, what is the 5 year local recurrence rate for stage I breast cancer treated with surgery and radiation?

A

5yr LR 7%

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60
Q

what percentage of craniopharyngioma patients will experience long-term diabetes insipidus?

A

60%

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61
Q

what are the most common breast cancer molecular subtypes associated with BRCA1 and BRCA2?

A

BRCA1 - triple negative / basal subtypeBRCA2 - luminal A/B

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62
Q

what 3 structures can be involved in stage II vulvar cancer?

A

lower urethra, vagina, anus

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63
Q

what structures comprise the CTV for IMRT for IB2 cervical cancer?

A

GTV, cervix, entire uterus, parametrium, upper half of vagina

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64
Q

What criteria makes a patient an ideal candidate for bladder preservation?

A

unifocal T2-3a tumor <5cm, no extensive CIS, no ureteral obstruction, good bladder capacity and renal function, visibly complete TURBT

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65
Q

what is the most likely diagnosis for a boy with a pineal mass and CSF with elevated bHCG and undetectable AFP?

A

pure germinoma, biopsy not required

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66
Q

following bladder preservation treatment, what percentage of long-term survivors will maintain an intact bladder?

A

80%

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67
Q

where do most ependymomas present in adults?

A

spine

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68
Q

what cell surface antigen is targeted by Zevalin (britumomab tiuxetan)?

A

CD20

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69
Q

what cell surface antigen is targeted by brentuximab?

A

CD30

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70
Q

On ECOG 5194 (DCIS +/- RT), what 2 factors indicated a higher risk of ipsilateral breast event?

A

nuclear grade, patient age

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71
Q

what is the appropriate adjuvant RT field and dose for a child with a 4th ventricular grade III non-metastatic ependymoma status post GTR?

A

RT to resection bed plus margin to 54-59.4Gy in 30-33fxs

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72
Q

what is the risk of conversion of solitary osseous plasmacytoma to multiple myeloma at 10 years? what about non-osseous plasmacytoma?

A

osseous - 54%non-osseous - 11%

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73
Q

what is the CSI dose for a child with persistent CSF involvement after chemotherapy for B-cell ALL?

A

24Gy

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74
Q

what are the indications for adjuvant CRT after radical hysterectomy for cervical cancer?

A

positive nodes, positive margins, parametrial involvement

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75
Q

for breast cancer, how many sentinel nodes are needed to give a 9% false negative rate?

A

3 nodes (false negative rate is 6% with 4 nodes)

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76
Q

what was the concurrent chemotherapy regimen utilized in NSABP R-03?

A

5-FU / leucovorin

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77
Q

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)?

A

10yr LRR 33% without PMRT, 7% with PMRT

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78
Q

what gastric lymph node stations are removed with a D2 dissection?

A

left gastric, celiac, common hepatic, splenic hilum, splenic artery

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79
Q

what is the most common RT regimen for Graves ophthalmopathy?

A

20Gy/10fxs

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80
Q

what is the most common type of childhood leukemia?

A

B-cell ALL

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81
Q

what subtype is not a classical subtype of Hodgkin Lymphoma and what are the molecular markers for that subtype?

A

nodular lymphocyte predominant CD15/CD30 negative, CD20/CD45 positive

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82
Q

what are the 4 subtypes of classic Hodgkin Lymphoma and what are the characteristic molecular markers?

A

nodular sclerosing, lymphocyte rich, mixed cellularity, lymphocyte poor CD15/CD30 positive, CD20/CD45 negative

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83
Q

what were the inclusion criteria for SWOG 8794 (prostatectomy +/- adjuvant RT)?

A

SVI, ECE, positive margin

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84
Q

on PORTEC-2, what was the 5yr rate of isolated vaginal recurrence for high-intermediate risk patients treated with brachytherapy versus those treated with EBRT?

A

5yr vaginal recurrence 1.8% with brachy, 1.6% with EBRT

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85
Q

what is the 5 year pelvic control rate for stage I/II SCCa of the mid-vagina treated with RT alone? what about stage III/IV?

A

stage I/II - 85%stage III/IV - 71%

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86
Q

invasion of what structures constitute stage II urethral cancer?

A

corpus spongiosumprostateperiurethral muscle

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87
Q

on RTOG 9811, what was the 5yr OS for patients with T4N+ anal cancer?

A

5yr OS 40%

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88
Q

what was the complete resection rate and 5yr OS in the SWOG 9416 superior sulcus tumor trial?

A

complete resection rate 76%5yr OS 44%

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89
Q

on GOG 37, what was the 2yr local recurrence rate for patients randomized to RT?

A

2yr LRR 5%

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90
Q

on GOG 33, what was the risk of pelvic lymph node involvement for a grade 1 tumor involving inner 1/3 versus outer 1/3 of the myometrium?

A

inner 1/3 - 3% risk of nodal involvementouter 1/3 - 11% risk

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91
Q

on Slotman trial for ES-SCLC, what was the benefit in median survival for patients who received PCI?

A

median survival 6.7mo vs. 5.4mo1yr OS 27% vs. 13%

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92
Q

what is the TD 5/5 for whole kidney?

A

23Gy

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93
Q

what is the age cutoff used for staging thyroid cancer?

A

age 45

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94
Q

male breast cancer is most commonly associated with what mutation?

A

BRCA2

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95
Q

what is the preferred doublet chemotherapy for unresectable mesothelioma?

A

cisplatin / pemetrexed (40% response rate)

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96
Q

what factors constitute IPI for advanced Hodgkin lymphoma?

A

stage IVmale sexage > 45albumin < 4hemoglobin < 10.5lymphocyte count < 600

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97
Q

what are the indications for whole abdominal radiation with favorable histology Wilms?

A

SPAR:diffuse SpillagePeritoneal seedingAscitespreoperative Rupture

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98
Q

what percentage of patients with urothelial carcinoma of the renal pelvis will also have a urothelial carcinoma of the bladder?

A

50%

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99
Q

per NSABP analysis, what is the 10yr local recurrence rate for patients with T3N0 breast cancer treated with mastectomy and chemotherapy (without PMRT)?

A

10yr LRR 7%

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100
Q

what constitutes T2 cholangiocarcinoma of the distal bile duct?

A

invasion beyond the wall of the bile duct

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101
Q

what constitutes T4 cholangiocarcinoma of the distal bile duct?

A

involves celiac axis or SMA

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102
Q

what tumor marker is used to follow granulosa cell ovarian cancers if elevated at diagnosis?

A

inhibin

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103
Q

on subgroup analysis of intermediate risk patients on RTOG 9408, what was the 10yr OS improvement with addition of short term ADT?

A

10yr OS improved by 7% (61% vs. 54%)

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104
Q

what triad of symptoms are associated with classic radiation induced liver disease (RILD)?

A

anicteric hepatomegalyasciteselevated alk phos

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105
Q

for grade II astrocytoma, what is the rate of transformation to high grade glioma?

A

70%

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106
Q

what percentage of CNS germ cell tumors in males occur in the pineal area?

A

60%

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107
Q

what IHC stains help distinguish mesothelioma from adenocarcinoma NSCLC?

A

calretinin, thrombomodulin

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108
Q

at what site do most male urethral cancers occur?

A

bulbomembranous urethra (60%), penile urethra (35%), prostatic urethra (5%)

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109
Q

what constitutes FIGO III fallopian tube cancer?

A

peritoneal implants outside of the pelvis (there is no FIGO IV by the way)

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110
Q

what percentage of penile cancers are HPV positive?

A

80%

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111
Q

what percentage of women with BRCA1 mutation will develop breast cancer and/or ovarian cancer by age 70?

A

60% will develop breast cancer40% will develop ovarian cancer

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112
Q

what is the 2 year rate of pelvic insufficiency fracture after definitive radiation for early stage cervical cancer?

A

35%

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113
Q

what constitutes T3 female urethral cancer?

A

invasion of vagina or bladder neck

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114
Q

what percentage of patients with LS-SCLC by conventional imaging will be upstaged by FDG PET?

A

10%

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115
Q

what is the maximum dose constraint for the spinal cord with 3 fraction SBRT?

A

18Gy

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116
Q

for high risk endometrial cancer, what are the two main options for adjuvant WPRT with brachy boost?

A

WPRT 45Gy, HDR 6Gy x 3 to surfaceWPRT 50.4Gy, HDR 6Gy x 2 to surface

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117
Q

for postop endometrial cancer, what are the 3 main HDR regimens?

A

6Gy x 5 to surface4Gy x 6 to surface7Gy x 3 to 5mm depth

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118
Q

what constitutes T2 hepatocellular carcinoma?

A

solitary tumor with vascular invasion or multiple tumors <5cm

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119
Q

what constitutes S2 testicular cancer?

A

LDH 1.5 - 10x upper limit of normal rangebHCG 5,000 - 50,000AFP 1,000 - 10,000

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120
Q

Langerhans cell histiocytosis is associated with what marker?

A

CD1a

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121
Q

what is the histologic feature of ependymoma?

A

perivascular psuedorosettes

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122
Q

what is the histologic feature of retinoblastoma?

A

Flexner-Wintersteiner rosettes

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123
Q

what is the histologic feature of diffuse astrocytoma?

A

microcystic changes

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124
Q

what is the histologic feature of medulloblastoma?

A

Homer-Wright rosettes

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125
Q

what was the surgery and adjuvant chemotherapy used in the CLASSIC trial?

A

D2 gastrectomyadjuvant oxaliplatin/capecitabine

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126
Q

what is the RT dose for MALT (gastric and orbit)?

A

30Gy/15fxs

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127
Q

what is the treatment paradigm for osteosarcoma?

A

neoadjuvant chemo, surgical resection, adjuvant chemo for 4-6 months (results in long term survival of 60% vs. just 20% with surgery alone)

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128
Q

what are the dose constraints for the duodenum when treating the paraaortics in the setting of GYN cancer?

A

D2cc < 60GyV55 < 15cc

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129
Q

what anatomical portion of the penis is most commonly involved in penile cancer?

A

glans - 50% (next most common is prepuce/foreskin at 25%)

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130
Q

what was the rate of pCR and/or minimal residual disease on SWOG 9416 superior sulcus tumor trial?

A

56%

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131
Q

for pancreatic cancer, what are the classic superior and inferior borders for adjuvant RT?

A

superior T10/11 interspaceinferior L3/4 interspace(superior border of T11, inferior border of L3)

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132
Q

what vertebral bodies correspond with the approximate levels of the celiac axis, SMA, and IMA?

A

celiac - T12SMA - L1IMA - L3

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133
Q

what mutation is associated with favorable prognosis in B-cell ALL?

A

t(12;21) - TEL/AML1

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134
Q

criteria for N2 anal cancer?

A

unilateral internal iliac and/or unilateral inguinal

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135
Q

what are the adjuvant chemo options for patients with pN2 NSGCT?

A

BEP x 2 cycles or EP x 2 cycles

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136
Q

what were the two treatment arms in RTOG 9512 for T2 glottic cancer?

A

70Gy/35fxs qday vs. 79.2Gy/66fxs BIDno significant difference LC, DFS, or OS

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137
Q

sorry dude this is gonna suck…what were the 4 treatment arms in RTOG 9003?

A

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

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138
Q

what were the 2 treatment arms in RTOG 8501 Herskovic trial for esophageal cancer?

A

64Gy/32fxs (RT alone) vs. 50Gy/25fxs with concurrent cis/5FU

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139
Q

what constitutes T2 pancreatic cancer?

A

> 2cm in size but confined to the pancreas

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140
Q

when treating stage I/II seminoma, what is the renal dose constraint?

A

D50 < 8Gy

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141
Q

per the new guidelines for APBI, what are the cautionary criteria for age, tumor size, and margin status?

A

age 40 - 49 (with no other risk factors)size 2.1 - 3.0cmmargin < 2mm

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142
Q

what was median survival on the CROSS trial?

A

50 vs 25 months (actually 49 vs 24 but lets not be ridiculous)

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143
Q

when should capecitabine be taken when used concurrently with radiation for rectal cancer?

A

1 hour before treatment

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144
Q

in treating with conventional fractionation for NSCLC, what is the appropriate CTV margin for adenocarcinoma and squamous histologies?

A

adeno - 8mmsquamous - 6mm

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145
Q

where is the motor cortex?

A

precentral gyrus

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146
Q

What is the 5-year overall survival for stage I, II, III, and IV oral cavity cancer?

A

I - 75%II - 55%III - 40%IV - 30%

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147
Q

What structures comprise the oral cavity?

A

lip, alveolar ridge, buccal mucosa, retromolar trigone, floor of mouth, oral tongue

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148
Q

What structures comprise the oropharynx?

A

palatine tonsils (fossa and pillars), soft palate, base of tongue, pharyngeal walls

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149
Q

What structures comprise the hypopharynx?

A

pyriform sinuses, postcricoid area, pharyngeal wall

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150
Q

GBM: RT fields and dose

A

CTV 46Gy - T2 + 2cmCTV 60Gy - T1 post / cavity + 2cm

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151
Q

GBM: temozolomide dosing during/after RT

A

during RT: 75mg/m2 dailyafter RT: 150-200mg/m2 days 1-5 on q28day cycle for 6 months

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152
Q

GBM: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses

A

chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 50Gylenses 7Gy

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153
Q

GBM: follow up

A

MRI one month after RT then ever 3 months thereafter

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154
Q

GBM: simulation

A

supine, mask, fuse preop and postop MRIs

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155
Q

GBM: RT options for elderly or poor KPS

A

Roa - 40Gy/15fxs, age > 60 and KPS > 50Bauman - 30Gy/10fxs, age > 65 and KPS < 50(French trial showed improved MS with RT compared to observation)

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156
Q

WHO 3 glioma: RT fields and dose

A

CTV 5940 - GTV/cavity + T2 flair + 2cm

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157
Q

WHO 3 glioma: chemotherapy

A

PCV: procarbazine, lomustine, vincristinegiven either before or after course of RT, possibly omit if 1p 19q codeletion is present

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158
Q

WHO 3 glioma: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses

A

chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 36Gylenses 5Gy

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159
Q

WHO 3 glioma: follow up

A

MRI one month after RT then ever 3 months thereafter

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160
Q

WHO 2 glioma: RT fields and dose

A

CTV 54Gy - GTV / T2 FLAIR + 2cm

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161
Q

Anal T2N0: RT fields and dose

A

CTV 42 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 50.4 - GTV + anal canal + 2.5cmPTV - 1cm margin

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162
Q

Anal T3-4N0: RT fields and dose

A

CTV 45 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 54 - GTV + anal canal + 2.5cm (consider 60Gy if T4)PTV - 1cm margin

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163
Q

Anal N+: doses

A

45Gy to elective nodal regions50.4Gy to nodal regions with nodes <3cm54Gy to primary and nodal regions with nodes >3cm

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164
Q

Anal: chemotherapy

A

two cycles at a 4 week interval:5FU 1000mg/m2 daily x 4 daysmitomycin 10mg/m2 x 1 day

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165
Q

Anal: workup

A

H&P: LN eval, DRE, anal sphincter tone, sexual history, HIV, HPV, IBD history, Gyn examLabs: CBC, HIV if risk factorsProctoscopy with bx. FNA of inguinal nodes. MRI or EUS.CT/MRI of A/P. CXR or CT chest

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166
Q

Rectal: criteria for WLE

A

T1, <3 cm, <30% circumference, margins >3mm, within 8 cm of anal verge, grade 1-2, no LVSI/PNI

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167
Q

Rectal: RT fields and dose (T3-4 or N+)

A

CTV 45 - mesorectum, presacrals, internal iliacs, obturatorsCTV 50.4 - tumor/mesorectum + 2cm sup/inf

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168
Q

Rectal: 2D fields

A

AP: L5/S1 down to bottom of obturator foramen or 3 cm below tumor, whichever is more inferior (anal verge for tumors close to anal verge), lat 2 cm on pelvic brimlat: want ant behind pubic symphysis and 3cm in front of sacral promontory, post 1cm behind sacrum If T4 with anterior structure invasion - move ant border in front of sacrum

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169
Q

Rectal: chemotherapy

A

preop with concurrent capecitabine 825mg bid M-Fadjuvant treatment for T3/4 or N+ is FOLFOX x 6 months

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170
Q

what are the components of FOLFOX

A

leucovorin (FOLinic acid)5FUOxaliplatin

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171
Q

what are the treatment options for early stage esophageal cancer (Tis, T1a, T1b, T2)?

A

Tis/T1a - endoscopic resection + ablationT1b - esophagectomyT2 - esophagectomy alone if noncervical, <2cm, well differentiated

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172
Q

definition of anal margin

A

area below anal verge encompassing 6cm of skin around anus, consists of keratinizing epithelum

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173
Q

definition of anal verge

A

area near end of anus where nonkeratinizing epithelium becomes keratinizing epithelium

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174
Q

What are the components of MAID chemotherapy?

A

MESNA, adriamycin, ifosfamide, dacarbazine

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175
Q

Pisters trial: P/D/R

A

P: 160 patients with extremity and superficial trunk sarcoma s/p WLED: adjuvant RT (brachy 45Gy) vs. observationR: RT improved local control for high grade lesions (90% vs. 65%) but not for low grade lesions (70%)

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176
Q

What were the local control rates for high grade sarcomas in the Pisters trial?

A

90% vs. 65%

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177
Q

NCI (Yang) trial, low grade portion: P/D/R

A

P: extremity sarcoma s/p WLED: adjuvant RT (63Gy total) vs. observationR: Local control improved with RT (95% vs. 60%)

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178
Q

NCI (Yang) trial, high grade portion: P/D/R

A

P: extremity sarcoma s/p WLED: adjuvant chemo vs. adjuvant chemo-RTR: Local control improved with RT (100% vs. 75%)

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179
Q

What was the chemotherapy regimen used in the NCI (Yang) trial?

A

doxorubicine, cyclophosphamide

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180
Q

NCI (Rosenberg) trial: P/D/R

A

P: 43 patients with high grade extremity sarcomaD: amputation vs. WLE + adjuvant RT (60-70Gy total)R: equivalent local control, DFS, and OS

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181
Q

NCIC (O’Sullivan) trial: P/D/R

A

P: 190 patients with extremity sarcomaD: neoadjuvant RT (50Gy) vs. adjuvant RT (66Gy)R: equivalent local control, DFS, and OS; more wound healing issues with neoadjuvant (35% vs. 15%); more late fibrosis with adjuvant (48% vs. 31%)

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182
Q

What were the rates of wound healing complications in the NCIC (O’Sullivan) trial?

A

35% vs. 15% (neoadjuvant vs. adjuvant)

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183
Q

What were the rates of late fibrosis in the NCIC (O’Sullivan) trial?

A

31% vs. 48% (neoadjuvant vs. adjuvant)

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184
Q

nasopharyngeal cancer CTV structures

A

nasopharynx, clivus, skull base, pterygoid fossa, parapharyngeal space, sphenoid sinus, posterior half of nasal cavity, posterior half of maxillary sinuses, inferior soft palate, retropharyngeal lymph nodes, retrostyloid space, bilateral nodal levels IB-V, cavernous sinus for T3/4

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185
Q

GBM volumes (RTOG)

A

CTV 46 is T2/FLAIR + 2cm, CTV 60 is contrast enhancing portion or surgical cavity + 2cm

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186
Q

RTOG GBM normal structure constraints (spinal cord, brain stem, optic chiasm 3mm PRV, optic nerve 3mm PRV)

A

spinal cord max 50, brainstem max 55 acceptable 60, optic chiasm 3mm PRV max 55 acceptable 60, optic nerve 3mm PRV max 55 acceptable 60

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187
Q

Nasopharyngeal carcinoma T1

A

tumor confined to nasopharynx or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension

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188
Q

Nasopharyngeal carcinoma T2

A

parapharyngeal extension

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189
Q

Nasopharyngeal carcinoma T3

A

skull base or paranasal sinuses

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190
Q

Nasopharyngeal carcinoma T4

A

intracranial extension, cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space

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191
Q

Nasopharyngeal carcinoma N1

A

unilateral cervical nodes <6cm

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192
Q

Nasopharyngeal carcinoma N2

A

bilateral cervical nodes <6cm

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193
Q

Nasopharyngeal carcinoma N3

A

nodes >6cm or extension to supraclavicular fossa

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194
Q

NPC extending into nasal cavity and parapharyngeal space with unilateral node <6cm

A

T2N1, stage II (T1N1 or T2N0-1)

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195
Q

NPC extending to nasal cavity with cervical nodes <6cm

A

T1N2, stage III (T1-2N2 or T3N0-2)

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196
Q

NPC extending to paranasal sinus with no cervical nodes

A

T3N0, stage III (T1-2N2 or T3N0-2)

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197
Q

NPC with skull base invasion and no cervical nodes

A

T3N0, stage III (T1-2N2 or T3N0-2)

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198
Q

NPC with skull base invasion and bilateral cervical nodes <6cm

A

T3N2, stage III (T1-2N2 or T3N0-2)

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199
Q

NPC with cranial nerve involvement and no cervical nodes

A

T4N0, stage IVA (T4N0-2)

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200
Q

NPC confined to nasopharynx with supraclavicular node

A

T1N3, stage IVB (any T, N3)

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201
Q

NPC with distant metastases

A

stage IVC

202
Q

Nasopharyngeal carcinoma T1

A

tumor confined to nasopharynx, or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension

203
Q

Nasopharyngeal carcinoma T2

A

parapharyngeal extension

204
Q

Nasopharyngeal carcinoma T3

A

invasion of skull base or paranasal sinuses

205
Q

Nasopharyngeal carcinoma T4

A

intracranial extension, involvement of cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space

206
Q

Nasopharyngeal carcinoma N1

A

unilateral cervical nodes <6cm

207
Q

Nasopharyngeal carcinoma N2

A

bilateral cervical nodes <6cm

208
Q

Nasopharyngeal carcinoma N3

A

nodes >6cm or extension to supraclavicular fossa

209
Q

Oropharynx T1

A

<2cm

210
Q

Oropharynx T2

A

2-4cm

211
Q

Oropharynx T3

A

> 4cm or extension to lingual surface of epiglottis

212
Q

Oropharynx T4a

A

invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible

213
Q

Oropharynx T4b

A

invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid

214
Q

Head & Neck N1

A

single ipsilateral node <3cm

215
Q

Head & Neck N2a

A

single ipsilateral node 3-6cm

216
Q

Head & Neck N2b

A

multiple ipsilateral nodes

217
Q

Head & Neck N2c

A

bilateral or contralateral nodes

218
Q

Head & Neck N3

A

> 6cm

219
Q

Lip and oral cavity T1

A

<2cm

220
Q

Lip and oral cavity T2

A

2-4cm

221
Q

Lip and oral cavity T3

A

> 4cm

222
Q

Lip and oral cavity T4a

A

Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin

223
Q

Lip and oral cavity T4b

A

invades masticator space, pterygoid plates, skull base, or encasing carotid

224
Q

Supraglottic larynx T1

A

limited to one subsite of supraglottis

225
Q

Supraglottic larynx T2

A

invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)

226
Q

Supraglottic larynx T3

A

vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage

227
Q

Supraglottic larynx T4a

A

invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)

228
Q

Supraglottic larynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

229
Q

Glottic larynx T1a

A

involves one vocal cord (normal mobility)

230
Q

Glottic larynx T1b

A

involves both vocal cords (normal mobility)

231
Q

Glottic larynx T2

A

impaired vocal cord mobility or involving supraglottic or subglottic larynx

232
Q

Glottic larynx T3

A

vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage

233
Q

Glottic larynx T4a

A

invades outer cortex of thyroid cartilage or tissues beyond larynx

234
Q

Glottic larynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

235
Q

NSCLC T1a

A

<2cm

236
Q

NSCLC T1b

A

2-3cm

237
Q

NSCLC T2

A

3-7cm, involving main bronchus >2cm distal to carina, invades visceral pleura, atelectasis extending to hilar region but not involving entire lung

238
Q

NSCLC T3

A

> 7cm, invades parietal pleura, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium, involves main bronchus <2cm from carina, atelectasis of entire lung, separate nodules in same lobe

239
Q

NSCLC T4

A

invades mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or nodules in separate ipsilateral lobes

240
Q

NSCLC N1

A

ipsilsteral intrapulmonary, peribronchial, or hilar nodes

241
Q

NSCLC N2

A

ipsilateral mediastinal or subcarinal nodes

242
Q

NSCLC N3

A

contralateral mediastinal or hilar nodes, scalene or supraclavicular nodes

243
Q

Breast T1mi

A

<1mm

244
Q

Breast T1a

A

<0.5cm

245
Q

Breast T1b

A

0.5-1cm

246
Q

Breast T1c

A

1-2cm

247
Q

Breast T2

A

2-5cm

248
Q

Breast T3

A

> 5cm

249
Q

Breast T4a

A

extension to chest wall not including pectorals muscle adherence/invasion

250
Q

Breast T4b

A

ulceration, edema / peau d’orange

251
Q

Breast T4c

A

both T4a and T4b

252
Q

Breast T4d

A

inflammatory carcinoma

253
Q

Breast cN1

A

mobile axillary nodes (levels 1-2)

254
Q

Breast cN2a

A

fixed/matted axillary nodes (levels 1-2)

255
Q

Breast cN2b

A

internal mammary nodes without axillary nodes

256
Q

Breast cN3a

A

ipsilateral infraclavicular nodes

257
Q

Breast cN3b

A

ipsilateral internal mammary AND axillary nodes

258
Q

Breast cN3c

A

ipsilateral supraclavicular nodes

259
Q

Breast pN1a

A

1-3 axillary nodes

260
Q

Breast pN2a

A

4-9 axillary nodes

261
Q

Breast pN3a

A

10 or more axillary nodes or infraclavicular node involvement (level 3)

262
Q

Esophagus T1a

A

invades mucosa (lamina propria or muscularis mucosa)

263
Q

Esophagus T1b

A

invades submucosa

264
Q

Esophagus T2

A

invades muscularis propria

265
Q

Esophagus T3

A

invades adventitia

266
Q

Esophagus T4a

A

Resectable tumor that invades pleura, pericarcium, or diaphragm

267
Q

Esophagus T4b

A

Unresectable tumor that invades adjacent structures

268
Q

Esophagus N1

A

1-2 regional nodes

269
Q

Esophagus N2

A

3-6 regional nodes

270
Q

Esophagus N3

A

7 or more regional nodes

271
Q

Rectum T1

A

invades submucosa

272
Q

Rectum T2

A

invades muscularis propria

273
Q

Rectum T3

A

invades through muscularis propria into pericolorectal tissue

274
Q

Rectum T4

A

invades adjacent structures

275
Q

Rectum N1

A

1-3 nodes

276
Q

Rectum N2a

A

4-6 nodes

277
Q

Rectum N2b

A

7 or more nodes

278
Q

Anus T1

A

<2cm

279
Q

Anus T2

A

2-5cm

280
Q

Anus T3

A

> 5cm

281
Q

Anus T4

A

invades adjacent organs

282
Q

Anus N1

A

perirectal lymph nodes

283
Q

Anus N2

A

unilateral internal iliac and/or inguinal nodes

284
Q

Anus N3

A

perirectal AND inguinal nodes, bilateral internal iliac or inguinal nodes

285
Q

Prostate T1a

A

incidental finding in less than 5% of tissue

286
Q

Prostate T1b

A

incidental finding in more than 5% of tissue

287
Q

Prostate T1c

A

tumor identified by needle biopsy (not palpable)

288
Q

Prostate T2a

A

involves less than half of one lobe

289
Q

Prostate T2b

A

involves more than half of one lobe

290
Q

Prostate T2c

A

involves both lobes

291
Q

Prostate T3a

A

extracapsular extension

292
Q

Prostate T3b

A

seminal vesical invasion

293
Q

Prostate T4

A

invasion of other organs/structures

294
Q

Cervix FIGO IA1

A

depth of invasion <7mm

295
Q

Cervix FIGO IA2

A

depth of invasion 3-5mm, horizontal spread <7mm

296
Q

Cervix FIGO IB1

A

clinically visible lesion <4cm

297
Q

Cervix FIGO IB2

A

clinically visible lesion >4cm

298
Q

Cervix FIGO IIA1

A

<4cm and involves upper vagina

299
Q

Cervix FIGO IIA2

A

> 4cm and involves upper vagina

300
Q

Cervix FIGO IIB

A

parametrial invasion

301
Q

Cervix FIGO IIIA

A

invades lower third of vagina

302
Q

Cervix FIGO IIIB

A

extends to pelvic wall or causes hydronephrosis and/or nonfunctioning kidney

303
Q

Cervix FIGO IVA

A

invades mucosa of bladder or rectum and/or extends beyond the true pelvis

304
Q

Cervix: what FIGO stage is regional node involvement?

A

FIGO IIIB

305
Q

Endometrium FIGO IA

A

invades less than half of the myometrium

306
Q

Endometrium FIGO IB

A

invades more than half of the myometrium

307
Q

Endometrium FIGO II

A

cervical stromal invasion

308
Q

Endometrium FIGO IIIA

A

involves ovaries or uterine serosa

309
Q

Endometrium FIGO IIIB

A

involves vagina or parametrium

310
Q

Endometrium FIGO IVA

A

invades bladder or bowel mucosa

311
Q

Endometrium: what FIGO stage is pelvic node involvement?

A

FIGO IIIC1

312
Q

Endometrium: what FIGO stage is para-aortic node involvement?

A

FIGO IIIC2

313
Q

Vulva FIGO IA

A

<1mm depth of invasion

314
Q

Vulva FIGO IB

A

> 2cm in size OR >1mm depth of invasion

315
Q

Vulva FIGO II

A

involves distal 1/3 urethra, distal 1/3 vagina, or anus

316
Q

Vulva FIGO IVA

A

involves upper 2/3 urethra, upper 2/3 vagina, bladder, rectum, or is fixed to pelvic bone

317
Q

Subsites of supraglottic larynx

A

false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds

318
Q

What are the 5 subsites of the oropharynx?

A

soft palate, palatine tonsils, tonsillar pillars, base of tongue (lingual tonsils), paryngeal wall

319
Q

1cm BOT tumor with no cervical nodes

A

T1N0, stage I (T1N0)

320
Q

2.5cm left tonsil tumor with no cervical nodes

A

T2N0, stage II (T2N0)

321
Q

5cm tumor of soft palate with no cervical nodes

A

T3N0, stage III (T3 or N1)

322
Q

3cm BOT tumor extending to lingual surface of epiglottis with single 2cm node

A

T3N1, stage III (T3 or N1)

323
Q

BOT tumor invading the medial pterygoid with single 2cm node

A

T4aN1, stage IVA (T4a or N2)

324
Q

2cm tumor of left tonsil with 4cm left cervical node

A

T1N2a, stage IVA (T4a or N2)

325
Q

1cm left tonsil tumor with 1cm right cervical node

A

T1N2c, stage IVA (T4a or N2)

326
Q

left tonsil tumor invading lateral pterygoid with no cervical nodes

A

T4bN0, stage IVB (T4b or N3)

327
Q

BOT tumor extending to lingual surface of epiglottis with 7cm cervical node

A

T3N3, stage IVB (T4b or N3)

328
Q

metastatic oropharyngeal cancer

A

stage IVC

329
Q

Oropharynx T1

A

<2cm

330
Q

Oropharynx T2

A

2-4cm

331
Q

Oropharynx T3

A

> 4cm or extension to lingual surface of epiglottis

332
Q

Oropharynx T4a

A

invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible

333
Q

Oropharynx T4b

A

invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid

334
Q

Head & Neck N1

A

single ipsilateral node <3cm

335
Q

Head & Neck N2a

A

single ipsilateral node 3-6cm

336
Q

Head & Neck N2b

A

multiple ipsilateral nodes

337
Q

Head & Neck N2c

A

bilateral or contralateral nodes

338
Q

Head & Neck N3

A

> 6cm

339
Q

Maxillary sinus T1

A

tumor limited to mucosa of maxillary sinus WITHOUT bone invasion

340
Q

Maxillary sinus T2

A

bone invasion (excluding posterior wall)

341
Q

Maxillary sinus T3

A

invasion of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygod fossa, ethmoid sinuses

342
Q

Maxillary sinus T4a

A

invasion of anterior orbit, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid sinus, frontal sinus

343
Q

Maxillary sinus T4b

A

invasion of orbital apex, dura, brain, middle cranial fossa, cranial nerves (excluding V2), nasopharynx, or clivus

344
Q

What are the 8 subsites of the oral cavity?

A

lips, gingiva, alveolus / alveolar ridge, buccal mucosa, retromolar trigone, hard palate, floor of mouth, oral tongue

345
Q

criteria for stage III head and neck cancer

A

T3 or N1

346
Q

criteria for stage IVA head and neck cancer

A

T4a or N2

347
Q

criteria for stage IVB head and neck cancer

A

T4b or N3

348
Q

Lip and oral cavity T1

A

<2cm

349
Q

Lip and oral cavity T2

A

2-4cm

350
Q

Lip and oral cavity T3

A

> 4cm

351
Q

Lip and oral cavity T4a

A

Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin

352
Q

Lip and oral cavity T4b

A

invades masticator space, pterygoid plates, skull base, or encasing carotid

353
Q

5 subsites of supraglottic larynx

A

false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds

354
Q

Supraglottic larynx T1

A

limited to one subsite of supraglottis

355
Q

Supraglottic larynx T2

A

invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)

356
Q

Supraglottic larynx T3

A

vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage

357
Q

Supraglottic larynx T4a

A

invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)

358
Q

Supraglottic larynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

359
Q

Glottic larynx T1a

A

involves one vocal cord (normal mobility)

360
Q

Glottic larynx T1b

A

involves both vocal cords (normal mobility)

361
Q

Glottic larynx T2

A

impaired vocal cord mobility or involving supraglottic or subglottic larynx

362
Q

Glottic larynx T3

A

vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage

363
Q

Glottic larynx T4a

A

invades outer cortex of thyroid cartilage or tissues beyond larynx

364
Q

Glottic larynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

365
Q

Subglottic larynx T1

A

limited to subglottis

366
Q

Subglottic larynx T2

A

extends to vocal cords with normal or impaired vocal cord mobility

367
Q

Subglottic larynx T3

A

vocal cord fixation

368
Q

Subglottic larynx T4a

A

invades cricoid cartilage, thyroid cartilage, or tissues beyond larynx

369
Q

Subglottic larynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

370
Q

Hypopharynx T1

A

<2cm, limited to one subsite of hypopharynx

371
Q

Hypopharynx T2

A

2-4cm, involves more than one subsite of hypopharynx

372
Q

Hypopharynx T3

A

> 4cm, fixation of hemilarynx, invasion of esophagus

373
Q

Hypopharynx T4a

A

invades thyroid cartilage, cricoid cartilage, hyoid bone, or thyroid gland

374
Q

Hypopharynx T4b

A

invades prevertebral space, mediastinal structures, or encasing carotid

375
Q

CROSS trial: P/D/R

A

P: 366 patients with resectable esophageal cancerD: surgery +/- neoadjuvant CRT (carboplatin, paclitaxel, 41.4Gy)R: improved OS with CRT (49mo vs. 24mo)

376
Q

What percentage of patients on the CROSS trial had adeno vs. SCCa?

A

75% adenocarcinoma23% squamous cell carcinoma2% large cell undifferentiated carcinoma

377
Q

Cross trial:overall path CRadeno path CRSCCa path CR

A

overall path CR: 29%adeno path CR: 23%SCCa path CR: 49%

378
Q

RTOG 9405 / INT 0123 (Minsky trial): P/D/R

A

P: 236 patients with T1-4 N0-1 M0 esophageal cancerD: concurrent chemotherapy (cisplatin/5-FU) with radiation to 50.4Gy vs. 64.8GyR: no difference in OS or LRR with higher radiation dose, multiple deaths in dose escalation arm occurred early in treatment

379
Q

RTOG 8501: P/D/R

A

P: 121 patients with esophageal cancerD: CRT (cisplatin/5-FU, 50Gy) vs. RT alone (64Gy)R: initial randomized portion closed early due to improved OS with CRT, 5yr OS 26% vs. 0%

380
Q

What chemotherapy regimens were used for the following:RTOG 8501RTOG 9405CROSS trial

A

RTOG 8501: cisplatin/5-FURTOG 9405: cisplatin/5-FUCROSS trial: carboplatin/paclitaxel

381
Q

What radiation doses were used in the following:RTOG 8501RTOG 9405CROSS trial

A

RTOG 8501: 50Gy with chemo, 64Gy aloneRTOG 9405: 50.4Gy, 64.8Gy (both with concurrent chemo)CROSS trial: 41.4Gy with chemo

382
Q

What are the two main studies supporting RT for DCIS?

A

NSABP B-17, EBCTCG meta-analysis

383
Q

What studies were included in the EBCTCG meta-analysis for DCIS?

A

SweDCIS, EORTC, UK/ANZ, NSABP B-17

384
Q

What was the IBTR with and without RT in NSABP B-17?

A

32% vs. 16%

385
Q

What was the IBTR with and without RT in the EBCTCG meta-analysis for DCIS?

A

28% vs. 13%

386
Q

What are the two main studies supporting observation following lumpectomy for DCIS?

A

RTOG 9804, ECOG (Hughes)

387
Q

RTOG 9804: entry criteria and difference in IBTR

A

low or intermediate grade 3mm, IBTR 6.7% vs. 0.9%

388
Q

ECOG (Hughes): entry criteria

A

low or intermediate grade 3mm

389
Q

ECOG (Hughes): IBTR by grade and age

A

low/int grade: 10.5% (7yrs)high grade: 15.3%high grade age 45: 10%

390
Q

Rate of tamoxifen use in RTOG 9804 and ECOG (Hughes)

A

RTOG 9804 - 62%ECOG (Hughes) - 40%

391
Q

What is the main study supporting the use of tamoxifen in DCIS?

A

NSABP B-24 (50Gy + TAM 5 years vs. 50Gy alone)

392
Q

NSABP B-24: IBRT

A

15% vs. 11%

393
Q

What are the two main studies supporting adjuvant RT for early stage breast cancer?

A

NSABP B-06, EBCTCG meta-analysis

394
Q

NSABP B-06: design

A

mastectomy vs. lumpectomy vs. lumpectomy + 50Gy, all underwent axillary dissection

395
Q

NSABP B-06: IBTR, OS

A

IBTR: 39% vs 14%OS: no difference

396
Q

What were the major trials included in the EBCTCG meta-analysis for early stage breast cancer?

A

NSABP B-06, Milan I, EORTC, Danish, NCI, Gustave-Roussy

397
Q

EBCTCG meta-analysis for early stage breast cancer: 10 year IBTR and BCM (N0 and N+)

A

IBTR: 35% vs. 19%BCM pN0: 21% vs. 17%BCM pN+: 51% vs. 43%

398
Q

What is the main study supporting adjuvant RT and tamoxifen for early stage breast cancer?

A

NSABP B-21

399
Q

NSABP B-21: design

A

TAM vs. TAM + 50Gy vs. placebo + 50Gy

400
Q

NSABP B-21: IBTR

A

TAM alone: 17%RT alone: 9%TAM + RT: 3%

401
Q

What are the two main studies evaluating boost for early stage breast cancer?

A

EORTC (Bartelink), Lyon

402
Q

EORTC breast boost trial: design

A

T1-2, N0-1, s/p lumpectomy and axillary dissection, 50Gy +/- 16Gy boost

403
Q

EORTC breast boost trial: IBTR by age

A

50yrs: 7% vs 4%

404
Q

Canadian (Whelan) hypofrac trial: design

A

T1-2 N0 post-lumpectomy, 42.5Gy/16 vs 50Gy/25, no boost

405
Q

START B: design

A

T1-3, N0-1 post lumpectomy, 40Gy/15 vs 50Gy/25, 61% received 10Gy boost

406
Q

What is the main study support observation following lumpectomy for elderly patients with early stage breast cancer?

A

CALGB (Hughes)

407
Q

CALGB (Hughes): design

A

> 70yrs, T1N0, ER+, TAM + RT (45Gy + 14Gy boost) vs TAM alone

408
Q

CALGB (Hughes): IBTR 10yrs

A

IBTR: 10% vs 2%

409
Q

NSABP B-04: design

A

cN0: radical mastectomy vs. total mastectomy vs. total mastectomy + axillary RTcN+: radical mastectomy vs. total mastectomy + axillary RT

410
Q

NSABP 32: design

A

SLNBx (with ALND if positive) vs. upfront ALND

411
Q

Z11: design

A

SLNBx positive: ALND + RT vs. RT alone

412
Q

AMAROS: design

A

SLNBx positive: ALND vs. RT

413
Q

DBCG 82b/c: high risk criteria

A

T3-4 or N+

414
Q

DBCG 82b: design

A

premenopausal patients: CMF + RT vs. CMF alone(cyclophosphamide, methotrexate, 5-FU)

415
Q

DBCG 82c: design

A

postmenopausal patients

416
Q

EBCTCG meta-analysis PMRT: BCM by nodes (20yrs)

A

N0: no OS differenceN1: BCM 42% vs. 50%N2+: BCM 70% vs. 80%

417
Q

Patchell I: design

A

surgery + WBRT vs. biopsy + WBRT

418
Q

Patchell I: median OS

A

3mo vs. 9mo

419
Q

Patchell I: what percentage of patients were found to not have metastases?

A

11%

420
Q

Patchell II: design

A

surgery +/- WBRT (50.4Gy!)

421
Q

Patchell II: brain recurrence

A

70% vs. 18%

422
Q

RTOG 9508: design

A

1-3 brain mets, WBRT + SRS boost vs. WBRT alone

423
Q

RTOG 9508: results

A

SRS boost improved median survival by 1-2 months for patients with single met

424
Q

RTOG 9402: design

A

WHO grade III glioma, PCV + RT vs. RT alone(procarbazine, CCNU (lomustine), vincristine)

425
Q

RTOG 9402: results

A

No difference in OS with RT, patients with 1p-19q codeletion MS 14.7 yrs vs. 7.3 yrs for patients without codeletion

426
Q

RTOG 9802: design

A

WHO grade II glioma, observation for low risk (age

427
Q

RTOG 9802: results

A

MS 13.3yrs vs. 7.8yrs - addition of PCV to radiation improves survival in high risk WHO grade II glioma

428
Q

EORTC “believers trial”: design

A

WHO grade I-II, adjuvant RT 45Gy vs. 59.4Gy

429
Q

EORTC “believers trial”: results

A

no difference in overall survival or progression free survival with dose escalation

430
Q

EORTC “nonbelievers trial”: design

A

WHO grade I-II, adjuvant RT 54Gy vs. observation

431
Q

EORTC “nonbelievers trial”: results

A

5yr PFS 55% vs. 35%, no difference in OS

432
Q

EORTC, anal cancer (Bartelink): design

A

RT with concurrent 5FU/mitomycin vs. RT alone

433
Q

EORTC, anal cancer (Bartelink): results

A

5yr LC 68% vs. 50%colostomy free survival 72% vs. 40%no difference in OS

434
Q

UKCCCR ACT I: design

A

RT with concurrent 5FU/mitomycin vs. RT alone

435
Q

UKCCCR ACT I: results

A

chemo improved LC and CFS but no improvement in OS

436
Q

What are the two main studies supporting the addition of chemotherapy to RT for anal cancer?

A

EORTC (Bartelink), UKCCCR ACT I

437
Q

What are the two main studies evaluating mitomycin vs cisplatin for anal cancer?

A

ACT II, RTOG 9811

438
Q

ACT II: results

A

similar toxicity, no difference in LC, CFS, or OS

439
Q

RTOG 9811: results

A

mitomycin improved 5yr OS (78% vs 71%) and CFS (725 vs 65%)

440
Q

What was the clinical question/answer with RTOG 0529?

A

anal cancer, when compared to results from RTOG 9811, IMRT results in reduced skin, GI, and heme toxicity

441
Q

CROSS trial: design

A

surgery alone vs. surgery with neoadjuvant CRT (41.4Gy, carboplatin/paclitaxel)

442
Q

CROSS trial: 5yr OS results

A

5yr OS 47% vs 34%

443
Q

CROSS trial: pCR rate(s)

A

pCR 29% (23% for adeno, 49% for SCCa)

444
Q

RTOG 8501: design

A

esophageal cancer definitive treatment, 64Gy vs. 50Gy + cisplatin/5FU

445
Q

RTOG 8501: 5yr OS

A

26% vs. 0%

446
Q

RTOG 9405 (Minsky): design

A

50.4Gy + 5FU/cisplatin vs. 64.8Gy + 5FU/cisplatin

447
Q

RTOG 9405 (Minsky): results

A

closed early, excess early deaths in dose escalation arm

448
Q

MAGIC trial: design

A

gastric cancer, surgery alone vs. surgery + pre and post-op ECF chemotherapy(epirubicin, cisplatin, 5FU)

449
Q

What chemo was used in the MAGIC trial?

A

ECF (epirubicin, cisplatin, 5FU)

450
Q

MAGIC trial: 5yr OS results

A

5yr OS 36% vs. 23%

451
Q

Intergroup / SWOG gastric cancer study: design

A

post-op observation vs. 45Gy + 5FU/leucovorin

452
Q

Intergroup / SWOG gastric cancer study: 5yr OS and criticisms

A

5yr OS 44% vs. 26%, D1 resection in 50%, D2 resection in 10%

453
Q

ARTIST trial: design

A

gastric cancer s/p surgery with D2 resection, adjuvant capecitabine/cisplatin vs. sequential chemo/RT/chemo

454
Q

ARTIST trial: results

A

no difference in OS, possibly due to extensive surgical resection (D2)

455
Q

CONKO: design

A

pancreas s/p resection, observation vs. gemcitabine

456
Q

CONKO: MS results

A

MS 22mo vs 20mo

457
Q

GITSG resectable pancreas: design

A

surgery alone vs. surgery + adjuvant RT + 5FU (40Gy split course)

458
Q

GITSG resectable pancreas: MS results

A

MS 20mo vs. 11mo

459
Q

EORTC resectable pancreas: design

A

adjuvant observation vs. CRT (40Gy split course, 5FU)

460
Q

EORTC resectable pancreas: results

A

no difference in PFS or OS with adjuvant CRT, per Bill Regine there is a benefit if a one-sided t-test is used

461
Q

ESPAC-1: design

A

2x2 factorial design, RT 40Gy, 5FU chemotherapy

462
Q

ESPAC-1: results and criticisms

A

reduced survival with patients receiving RT, not really randomized, no RT quality assurance, wide range of RT doses used

463
Q

RTOG 9704: design

A

adjuvant 5FU vs gemcitabine(5FU vs gem -> 50.4Gy with 5FU -> 5FU vs gem)

464
Q

RTOG 9704: results

A

nonsignificant trend toward improved survival with gemcitabine

465
Q

NEJM FOLFIRINOX vs. gemcitabine for metastatic pancreatic cancer: results

A

MS 11mo vs 7mo(leucovorin, 5FU, irinotecan, oxaliplatin)

466
Q

Dutch rectal cancer study: design and results

A

design: preop RT (25Gy/5) + TME vs. TME alone,results: 10yr LR 5% vs 11%

467
Q

Swedish rectal cancer study: design and results

A

design: preop RT (25Gy/5) + surgery vs. surgery alone (TME not used)results: 13yr OS 38% vs. 30%, LR 9% vs 27%

468
Q

German rectal cancer study: design

A

preop CRT (50.4Gy, 5FU) vs postop CRT (50.4Gy, 5.4Gy boost, 5FU)

469
Q

German rectal cancer study: results

A

5yr LR 6% vs. 13% favoring preop

470
Q

Rectal cancer: what was the pCR rate on the German rectal cancer study and NSABP R-04?

A

German: pCR 8% (concurrent 5FU)NSABP R-04: pCR 21% (concurrent capecitabine)

471
Q

BC2001: design

A

two randomizations:1. concurrent 5FU/mitomycin vs. no chemo2. standard volume RT vs. reduced high dose volume RT

472
Q

BC2001: results

A

nonsignificant trend toward improved OS with chemotherapy (48% vs 35%)

473
Q

RTOG meta-analysis for bladder preservation: pCR, 5yr intact bladder, 5yr OS

A

pCR 69%5yr intact bladder 80%5yr OS 57%

474
Q

seminoma, MRC 18: design and results

A

PA field, adjuvant 30Gy vs 20Gy, no difference in local control

475
Q

seminoma, MRC 10: design and results

A

30Gy, dogleg vs. para-aortic field, less toxicity with PA field but slightly increased risk of pelvic relapse

476
Q

Bill-Axelson / Scandinavian study: entry criteria and design

A

age 10yrs, operable T1-2, PSA

477
Q

Bill-Axelson / Scandinavian study: results

A

improved survival in men

478
Q

What are the eight dose escalation studies in prostate cancer?

A
  1. MDACC (Pollack)2. Brazil meta-analysis3. GETUG4. Dutch5. MGH PROG6. MRC RT017. Ontario8. Fox Chase
479
Q

MDACC prostate dose escalation: design and results

A

70Gy vs. 78Gy, failure free survival significantly improved with dose escalation

480
Q

EORTC high risk prostate (Bolla): design

A

RT 70Gy +/- concurrent and adjuvant ADT (36mos)

481
Q

EORTC high risk prostate (Bolla): 10yr OS results

A

10yr OS 58% vs 40%

482
Q

RTOG 9202: design

A

mostly high risk patients, RT 65-70Gy and 4mos NCADT +/- 24mos adjuvant ADT

483
Q

RTOG 9202: results

A

long term ADT improved LR and CSS; OS improvement in GS 8+ patients

484
Q

GOG 122: population and design

A

stage III or IV endometrial cancer s/p resection, adjuvant chemo (doxorubicin/cisplatin) vs. WART (30Gy + 15Gy boost)

485
Q

GOG 122: 5yr OS

A

5yr OS 53% vs 42%

486
Q

GOG 37 (Homesley): population and design

A

vulvar cancer with positive groin nodes after vulvectomy and lymphadenectomy; pelvic node dissection vs. RT to bilateral pelvic and inguinal nodes

487
Q

GOG 37 (Homesley): 6yr OS

A

6yr OS 41% vs. 51%

488
Q

GOG 88: population and design

A

vulvar cancer, clinically N0; vulvectomy + groin dissection vs. vulvectomy + adjuvant inguinal RT (50Gy)

489
Q

GOG 88: results and criticism

A

LR 19% vs. 0%; 20% received groin dissection and RT, OS 88% vs 63%, RT was prescribed to 3cm and often underdosed

490
Q

GOG 92 (Sedlis): population and design

A

stage IB, two of 3 criteria (>1/3 stromal invasion, LVSI, >4cm tumor), all had radical hysterectomy and pelvic lymphadenectomy, randomized to adjuvant RT vs. observation

491
Q

GOG 92 (Sedlis): 10yr LR and OS

A

10yr LR 21% vs 14%10yr OS 80% vs 71% (NS)

492
Q

GOG 109 (Peters): population and design

A

stage IA2-IIA s/p radical hysterectomy with positive nodes, positive nodes, OR parametrial invasion; RT +/- chemo (cisplatin, 5FU)

493
Q

GOG 109 (Peters): 4yr OS

A

4yr OS 71% vs 81%

494
Q

GOG 123 (Keys): population and design

A

IB2 cervical cancer, RT -> hyst vs. CRT -> hyst

495
Q

GOG 123 (Keys): 3yr OS

A

3yr OS 74% vs 83%

496
Q

GOG 120: population and design

A

cervical cancer stage IIB-IVA, definitive CRT with cisplatin vs hydroxyurea vs both

497
Q

GOG 120: results

A

OS better with weekly cisplatin; less toxicity with cisplatin vs. cisplatin + hydroxyurea

498
Q

RTOG 9001: population and design

A

cervical cancer stage IIB-IVA, RT vs CRT (cisplatin, 5FU)

499
Q

RTOG 9001: 8yr OS

A

8yr OS 41% vs 67%

500
Q

RTOG 7920: population, design, results

A

cervical cancer IB-IIB, WPRT vs EFRT, improved OS with EFRT

Errthing (12 decks)

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