Breast Cancer

Stage what!??

100

Appropriate surgical margin for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer (Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins)

What is no ink on tumor as the standard for an adequate margin in invasive cancer. In the era of multidisciplinary therapy this is is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

200

12mm RUOQ mass and 10mm right internal mammary lymph node

What is T1cN2b, Stage IIIA?

300

Criteria for inflammatory breast cancer

What is: (1)Rapid onset of breast erythema, edema and/or peau d’orange, and/or warm breast, with or without an underlying palpable mass. (2) Duration of history no more than six months. (3) Erythema occupying at least one-third of the breast. (4) Pathologic confirmation of invasive carcinoma.

400

1.6 cm movable axillary lymph node and occult breast primary

What is T0N1, Stage II?

500

Treatment arms as well as 10-year overall survival and disease-free survival for each arm in "Regional Nodal Irradiation in Early-Stage Breast Cancer" [Whelan et al. NEJM 2015]

What is among women with node-positive or high-risk node-negative breast cancer, the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence. At the 10-year follow-up, there was no significant between-group difference in survival, with a rate of 82.8% in the nodal-irradiation group and 81.8% in the control group (hazard ratio, 0.91; 95% confidence interval [CI], 0.72 to 1.13; P=0.38). The rates of disease-free survival were 82.0% in the nodal-irradiation group and 77.0% in the control group (hazard ratio, 0.76; 95% CI, 0.61 to 0.94; P=0.01). http://www.nejm.org/doi/full/10.1056/NEJMoa1415340

Do you really want to order that?

100

Mammogram report says BiRads 3.

What is probably benign finding, short follow-up? http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammo-report

200

The USPSTF recommends biennial screening with mammography for this age group.

What is the women aged 50-74 years.

300

Criteria for screening with annual MRI and mammography from the Ontario High Risk Breast Screening Program

What is (1) known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, (2) untested first-degree relative of a gene mutation carrier, (3) family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or (4) radiation therapy to the chest (before age 30 years and at least 8 years previously). Also, age 30-69 and no symptoms. http://ascopubs.org/doi/pdf/10.1200/JCO.2013.52.8331

400

5-year OS and DFS in Z0011. "Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node MetastasisA Randomized Clinical Trial" [Giuliano et al. 2011 JAMA] BONUS: how many patients received high tangent fields or regional nodal RT?

What is 5-yr OS 91.8% (ALND) vs 92.5% (SLND). 5-yr DFS 82.2% (ALND) vs 83.9% (SLND). - 185 patients (81.1%) received tangent-only treatment: High tangent RT fields (with cranial tangent border within 2 cm of the humeral head) were used in 52.6% (40/76) patients randomized to the ALND arm and 50% (33/66) patients randomized to the SLND arm. - Of the 228 patients with records reviewed, 43 (18.9%) received directed regional nodal RT using ≥3 fields: 22 in the ALND and 21 in the SLND arm. http://jamanetwork.com/journals/jama/fullarticle/645514

500

The rate of increase in major coronary events in "Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer" [Darby et al. NEJM 2013] Define major coronary event and mean heart dose.

What is the rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001). Myocardial infarction, coronary revascularization, or death from ischemic heart disease Mean heart dose 4.9 Gy (range, 0.03 to 27.72) http://www.nejm.org/doi/full/10.1056/NEJMoa1209825

8 Gy to the ...

100

Percentage of patients with metastatic breast cancer who will develop brain metastases

What is 15–30 %? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717619/#CR7

200

Half-life of radium 223. BONUS: Most common Grade3/4 toxicity in "A phase IIa, nonrandomized study of radium-223 dichloride in advanced breast cancer patients with bone-dominant disease."

What is 11.4 days? What is anorexia (14%)?

300

This is the starting SBRT dose and fractionation for osseous/spinal/paraspinal mets in NRG BR001?

What is 30 Gy in 3 fractions?

400

10-year incidence of local recurrence in each arm of "Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial." [Bartelink et al. JCO 2007]

What is at 10 years the cumulative incidence of local recurrence was 10.2% (no boost) versus 6.2% (boost) (P < .0001). The hazard ratio of local recurrence was 0.59 (0.46 to 0.76) in favor of the boost, with no statistically significant interaction per age group. The absolute risk reduction at 10 years per age group was the largest in patients ≤ 40 years of age: 23.9% to 13.5% (P = .0014).

500

Stratification and treatment arms of RTOG 1119

What is (1) Graded Prognostic Assessment (GPA) Score: 1.5-2 vs. 2.5-3 vs. 3.5-4 (2) Use of Non-CNS–Penetrating HER2 Blockade at Study Entry: No vs. Yes: trastuzumab ± pertuzumab (3) RT to Be Used: WBRT vs SRS Arms: Radiation (WBRT or SRS) plus/minus Lapatinib

Faster is better

100

Margins used in B39 for external beam APBI?

What is 15mm (CTV) and 10mm (PTV)?

200

Trial with interim analysis that demonstrated that 3D conformal APBI increased rate of adverse cosmesis and late radiation toxicity compared with standard whole breast irradiation

What is "Interim Cosmetic and Toxicity Results From RAPID: A Randomized Trial of Accelerated Partial Breast Irradiation Using Three-Dimensional Conformal External Beam Radiation Therapy." (Olivotto IA, J Clin Oncol. 2013)

300

Skin and rib dose constraints for BALLOON brachytherapy

What is skin maximum: ≤ 125% prescribed dose, rib maximum: ≤ 145% prescribed dose?

400

Treatment arms in the Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomized controlled equivalence trial

What is: patients in the intraoperative radiotherapy group received one dose of 21 Gy to the tumour bed during surgery. Those in the external radiotherapy group received 50 Gy in 25 fractions of 2 Gy, followed by a boost of 10 Gy in five fractions.

500

The updated 2016 ASTRO criteria for "suitable" candidates with DCIS for APBI (name ALL of them)

What is http://www.practicalradonc.org/article/S1879-8500(16)30184-9/fulltext

Your mama

100

NSABP B43 study population and treatment arms

What is B43 (a phase III trial comparing trastuzumab concurrently with RT versus RT alone for HER2-positive DCIS following by lumpectomy)

200

Other than BRCA1/2, mutations in these genes are associated with inherited breast cancer (name 3 of the 7 most common)

What is: ATM CDH1 CHEK2 PALB2 PTEN STK11 TP53 (p53)

300

Mutations of BRCA1 and BRCA2 confer a lifetime risk of breast cancer of between __ and __ percent and a lifetime risk of ovarian cancer of between __ and __ percent. Lifetime risk Angelina Jolie was told before surgery.

What is 60 - 85%, and 15 - 40%? 87% lifetime risk http://www.nejm.org/doi/full/10.1056/NEJMra012284

400

Define "high dose gradient" in Dr. Z's single fraction trial

What is 20Gy to cavity and 7Gy cavity +1cm

500

At 10 years, these outcomes were improved with nodal radiation in "Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer" [Poortmans et al. NEJM 2015]

What is at 10 years, the rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (P=0.02). OS was 82.3% in the nodal-irradiation group and 80.7% in the control group (P=0.06).