Breast
Which patient would gain the greatest benefit in local control from RT? A. 0.9 cm grade 3 DCIS s/p lumpectomy with negative margin B. 1.8 cm grade 2 DCIS s/p lumpectomy with negative margin C. 7 cm DCIS s/p mastectomy with negative margins D. 4.5 cm DCIS s/p mastectomy with a positive margin
0.9 cm grade 3 DCIS s/p lumpectomy with negative margin (grade 3 = higher risk DCIS)
What is the BEST treatment for a 55 year-old female who underwent breast-conserving surgery for a pT1cN1mi cM0 ER+ HER2- breast cancer and 21 gene recurrence score of 22? Include RT and systemic therapy recs.
RT followed by endocrine therapy
For which age group does the use of screening mammography avoid the most breast cancer deaths? A. 39 - 49 B. 50 - 59 C. 60 - 69 D. 70 - 74
60 - 69
What is the recommended conventionally fractionated prescription dose range for non-functioning pituitary adenomas?
45 - 54 Gy
What function is associated with the occipital lobe of the brain?
vision
What were the 5-year local control results for the 1-week regimens of the FAST-Forward phase III RCT as compared to 3-week hypofractionated breast RT? A. Increased ipsilateral breast tumor relapse B. Increased locoregional relapse C. Non-inferior ipsilateral breast tumor relapse D. Non-inferior ipsilateral breast tumor relapse but increased locoregional relapse
Non-inferior ipsilateral breast tumor relapse. Remember: 40 Gy in 15 fractions, 27 Gy in 5 fractions over 1 wk, and 26 Gy in 5 fractions over 1 wk. IBTR 2.1%, 1.7% and 1.4%. Patient and photographic assessments showed higher normal tissue effect risk for 27 Gy
Which is associated with the highest risk of locoregional recurrence after neoadjuvant chemotherapy in breast cancer? A. Clinically node negative with residual nodal disease after chemotherapy B. Complete response in the lymph nodes and the breast C. Complete response in the lymph nodes but not the breast D. Clinically node positive with residual nodal disease after chemotherapy
Clinically node positive with residual nodal disease after chemotherapy
In the 2014 Early Breast Cancer Trialists' Collaborative Group meta-analysis examining the effect of PMRT after MRM, what was the decrease in 20-year breast cancer mortality with the use of RT for those with node-positive breast cancer? A. 3% B. 8% C. 13% D. 18%
8%
What imaging characteristic of glioma is MOST indicative of low grade histology? A. Intratumoral hemorrhage B. High relative cerebral blood volume C. Marked mass effect D. Lack of contrast enhancement
Lack of contrast enhancement
What connects the lateral and third ventricles?
Foramen of Monro
Which clinical finding is characteristic of locally advanced breast cancer? A. Bloody nipple discharge B. Mobile axillary lymph nodes C. Nipple retraction D. Palpable supraclavicular node
Palpable supraclavicular node
Which characteristic is MOST typical of an inflammatory breast cancer? A. A discrete breast mass B. Slow disease progression C. Erythema over an otherwise normal breast D. Warmth and edema
Warmth and edema
Which of the following is NOT used in calculating a patient’s Child-Pugh Score? A. Ascites B. Bilirubin C. Creatinine D. Albumin
Creatinine
A histological WHO grade II diffuse astrocytic glioma is found to be IDH wild-type. Which molecular criteria would suggest this glioma will follow an aggressive clinical course like glioblastoma? A. 1p/19q codeletion B. TERT promoter mutation C. Lack of MGMT methylation D. SYT gene amplification
TERT promoter mutation (histologic grade II and III IDH-wildtype diffuse astrocytic gliomas which contain high-level EGFR amplification, the combination of whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10), or TERT promoter mutations, correspond to WHO grade IV and should be referred to as diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV.)
What is the MOST important component of treatment for primary CNS lymphoma? A. High-dose systemic methotrexate B. Cycloplosphamide, doxorubicin, vinctristine and prednisone (CHOP) C. Whole brain RT D. Rituximab
High-dose systemic methotrexate
What is the TMN classification in a patient that presents with a 5 cm, grade 3 breast cancer with matted axillary lymph nodes, received neoadjuvant chemotherapy, and had a pCR at time of MRM?
cT2N2aM0, ypT0N0
For which brachytherapy APBI technique do randomized trial data support equivalent rates of LR with whole breast RT?
Multi-catheter interstitial- Hungarian trial and the larger GEC-ESTRO trial
What is the approximate local control rate at 1 year for a 2 cm hepatocellular carcinoma treated with SBRT to BED > 100 Gy? A. 85 - 100% B. 70 - 84% C. 55 - 69% D. 40 - 54%
85 - 100%
In a randomized phase III trial, the addition of which agent to standard temozolomide chemoRT and adjuvant temozolomide for GBM with methylated MGMT promoter improved OS? A. Procarbazine B. Lomustine C. Bevacizumab D. Vincristine
Lomustine- Median overall survival was improved from 31·4 months to 48·1 months
What factor is associated with better prognosis in primary CNS lymphoma? A. Age younger than 30 years B. Elevated LDH level C. Involvement of cerebellum D. Performance status 0 or 1
Performance status 0 or 1
hat heart and lung dose constraints are acceptable for PMRT planning? A. Mean heart dose of 4 Gy and ipsilateral lung V20 of 35% B. Mean heart dose of 6 Gy and total lung V20 of 35% C. Mean heart dose of 4 Gy and total lung V30 of 35% D. Mean heart dose of 6 Gy and ipsilateral lung V30 of 35%
Mean heart dose of 4 Gy and ipsilateral lung V20 of 35%
For a 54 year-old woman with newly diagnosed metastatic ER- PR- HER2+ breast cancer and an ECOG of 0, what is the preferred first-line systemic therapy?
Trastuzumab, pertuzumab, and docetaxel, per cleopatra study 8-year overall survival rate from 23% to 37%by adding pertuzumab
What is the MINIMUM volume of uninvolved liver that must be spared from receiving a critical dose threshold in liver SBRT? A. 400 cc B. 700 cc C. 900 cc D. 1500 cc
700 cc
At what level does the thecal sac end in adults?
S1/S2- best seen on sagittal T2 MRI
In the WHO 2016 classification of brain tumors, which molecular feature is required for the diagnosis of an oligodendroglioma? A. IDH wild type B. Combined 1p/19q loss C. TERT promoter mutation D. EGFR amplification
Combined 1p/19q loss. Oligo needs both requires the presence of both an isocitrate dehydrogenase (IDH) mutation and combined 1p/19q loss.