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MCQ on Radiotherapy
1. For which of the following clinical scenarios would liver SBRT be a recommended treatment ?
(1) Resectable extrahepatic cholangiocarcinoma
(2) 7 cm HCC tumor invading the portal vein with Child Pugh A cirrhosis
(3) Metastatic rectal cancer with a solitary 5 cm liver metastasis invading the duodenum
(4) Metastatic colorectal cancer with 3 subcentimeter liver metastases, and bilateral lung metastases
2. A patient undergoes radical inguinal orchiectomy for an 8 cm right testicular seminoma Pathology showed invasion of rete testes and LVSI; and there was no nodal involvement on scans; serum markers returning to normal levels after surgery. What is the recommended RT technique?
(1) 30 Gy with right sided “dog leg” field
(2) 30 Gy with para-aortic only field
(3) 20 Gy with right sided “dog leg” field
(4) 20 Gy with para-aortic only field
3. Early Breast Cancer Trialists Collaborative Group (EBCTCG 2014) meta-analysis of post-mastectomy trials, what was the impact of RT in women with 1-3+ nodes who underwent an axillary dissection and received systemic therapy ?
(1) It was detrimental in this population
(2) It yielded no benefit
(3) It improved locoregional control only
(4) It improved locoregional control and breast cancer specific survival
4. In the START B Trial, which endpoint was not superior in the hypo-fractionation arm ?
(2) Breast edema
(3) Local recurrence
(4) Breast shrinkage
5. In the HD 16 randomized control trial comparing the role of radiotherapy for favourable Hodgkin patients that have negative PET scans (defined as Deuville score <3) after 2 cycles of ABVD, what was the impact of RT ?
(1) Increased PFS and OS
(2) Increased PFS but not OS
(3) Increased PFS but decreased OS
(4) Increased PFS and OS
6. After definitive chemo-radiation for treatment of anal cancer, what is the minimum length of time (months) to wait before performing a biopsy on a persistent, but responding mass ?
(1) 1 month
(2) 3 months
(3) 6 months
(4) 12 months
7. For a patient with locally advanced oesophageal cancer endoscopically visualized at 20 cm from the incisors, which of the following diagnostic tests is not indicated ?
(4) Endoscopic ultrasound
8. What was the approximate median OS (years) of patients with Ipl9q Co-deleted gliomas following PCV and sequential RT on RTOG 9402 ?
9. What treatment is recommended for state ITA squamous cell carcinoma of the vagina ?
(1) EBRT + brachytherapy
(2) Brachytherapy alone
(3) Wide local excision
(4) Laser ablation
10. What is the most appropriate management for a 37-year-old patient with Stage IA nodular sclerosing Hodgkin lymphoma, non-bulky, involving the right cervical neck, with baseline ESR of 15 and LDH of 200 ?
(1) ABVD x 2 cycles + no RT
(2) ABVD x 2 cycles + 20 Gy RT
(3) ABVD x 4 cycles + 20 Gy RT
(4) ABVD x 4 cycles + 30 Gy RT
11. What is the recommended prescription dose range when using 1-5 fraction stereotactic radiation to treat functioning pituitary adenomas ?
(1) 2-12 Gy
(2) 20-35 Gy
(3) 45 – 54 Gy
(4) 55-65 Gy
12. According to the IMRT Contouring guidelines for treating intact cervix squamous cell carcinoma when there is no vaginal involvement, what proportion of the vagina is required to be included in the CTV ?
13. Which of the following cranial nerves runs through the cavernous sinus ?
14. What is the approximate anatomical landmark of the renal hilum ?
15. Appropriate method of therapeutic intensification for the post-operative radiotherapy treatment of inflammatory breast cancer :
(1) A hypofractionated regimen
(2) The use of daily bolus
(3) An axillary boost
(4) Inclusion of the contralateral IM chain
16. Most appropriate treatment for pT1IN2b squamous cell carcinoma of the lateralized oral tongue :
(1) Radiation therapy with definitive intent
(2) Induction chemotherapy followed by surgery
(3) Radiation therapy and concurrent chemotherapy
(4) Surgery and adjuvant therapy as indicated by pathology
17. Recommended maximum dose to the optic apparatus in single fraction radiosurgery to result in < 1% risk of radiation-induced optic neuropathy per NTCP modelling :
(1) 7 Gy
(2) 10 Gy
(3) 12 Gy
(4) 15 Gy
18. What is the median survival for primary CNS lymphoma following WBRT alone ?
(1) 2 months
(2) 36 months
(3) 24 months
(4) 12 months
19. Meta-analysis of chemotherapy is head and nech cancer (MACH-NC), what was the 5-year OS benefit of adding concurrent chemotherapy to RT ?
20. Treatment is recommended for a 55- year-old female with pTINImic grade I, ER/PR +ve HER-2-ve breast cancer following breast-conserving surgery and sentinel node biopsy whose recurrence score is 11 :
(1) Completion axillary LND followed by hypofractionated whole breast RT and adjuvant endocrine therapy
(2) Chemotherapy followed by hypofractionated whole breast and low axillary RT and adjuvant endocrine therapy.
(3) APBI followed by adjuvant endocrine therapy
(4) Hypofractionated whole breast RT followed by adjuvant endocrine therapy
21. What is the approximate pCR rate after pre-operative RT in patients with soft tissue sarcoma ?
22. Which molecular subgroup of medulloblastoma has the BEST prognosis ?
(1) WNT (wingless)
(2) SHH (sonic hedgehog)
(3) Group 3
(4) Group 4
23. What is the main rationale for using deep inspiration breath hold (DIBH) in breast treatments ?
(1) Decreased dose inhomogeneity
(2) Decreased breast separation
(3) Increased heart sparing
(4) Increased oesophagus sparing
24. What is the definitive radiation dose for stage-I lymphoma involving mucosa-associated lymphoid tissue (MALT) of the left parotid gland ?
(1) 24 Gy
(2) 36 Gy
(3) 45 Gy
(4) 50.4 Gy
25. What is the most common histology in paediatric brain tumor ?
(4) Pilocytic astrocytoma
26. Which pathologic feature of endometrial cancer would prompt inclusion of the presacral lymphatics in the CTV for adjuvant RT ?
(1) Cervical stromal involvement
(2) Deep myometrial invasion
(3) Uterine fundal involvement
(4) Extensive LVI
27. All of the following isotopes are used for permanent prostate seed implants except:
(1) Todine 125
(2) Palladium 103
28. Increased tumor cell kill of relatively radiation resistant hypoxic cells can be achieved by the concurrent administration of radiation and any of the following drugs except :
29. Which molecular features of low grade gliomas are associated with improved OS ?
(1) Wild type IDH and = mutant PIK3CA
(2) Mutant IDH and Ip/19q codeletion
(3) Wild type IDH and wild type PIK3CA
(4) Mutant IDH and no 1p/19q codeletion
30. What is abscopal effect ?
(1) Localized response following SBRT
(2) Synergistic effect at the irradiated site
(3) Systemic effects of immunosuppression
(4) Therapeutic effect at distance from irradiated site
31. What is the rate of complete response in muscle-invasive bladder cancer treated with TUR-BT and Chemo-RT ?
32. Which treatment with the best reported OS for a newly diagnosed glioblastoma
(1) RT alone
(2) RT with concurrent temozolomide and adjuvant temozolomide
(3) RT with concurrent temozolomide and adjuvant temozolomide + bevacizumab
(4) RT with concurrent temozolomide and adjuvant temozolomide + tumor-treating fields
33. What is the approximate local control after radiation for pituitary adenomas ?
34. Patient presents with right neck adenopathy. Biopsy shows carcinoma positive for EBV. Imaging, examination and EUA indicate no primary site of disease. Which staging system is used ?
(3) Unknown primary
(4) Head and neck skin
35. When using a larynx preservation approach for locally advanced SCC of the supraglottis, which treatment paradigm has the best local control ?
(1) Concurrent chemo-radiation
(2) Hyper fractionated radiation
(3) Induction chemotherapy then radiation
(4) Induction chemotherapy then chemo-radiation
36. Which of the following options describe the best management strategy for SCLC by AJCC stage grouping ?
(1) Stage 1 SCLC-Lobectomy and adjuvant chemotherapy followed by consideration of PCI
(2) Stage If SCLC-Chemo-radiation and consolidation with durvalumab with no PCI
(3) Stage III SCLC-Chemo-radiation therapy followed by lobectomy and PCI.
(4) Stage TV SCLC-Chemotherapy followed by consolidation thoracic RT to 45 Gy in 15 fractions and PCI.
37. What is the purpose of the dummy wire in 192Ir HDR remote after loader unit?
(1) To confirm that the correct patient is being treated
(2) To confirm that the path the radioactive source travels is clear of obstruction
(3) To measure the activity of the radioactive source along the path of travel
(4) To measure the dwell time accuracy of the radioactive source
38. According to the ASTRO guideline update on palliative RT for bone metastases, what fractionation schemes were shown to have pain relief equivalency in the treatment of previously unirradiated painful peripheral bone metastases ?
(1) 8 Gy in 1 fraction, 20 Gy in 4 fractions, and 24 Gy in 6 fractions
(2) 8 Gy in 1 fraction, 20 Gy in 4 fractions, and 30 Gy in 10 fractions
(3) 8 Gy in 2 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions
(4) 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 37.5 Gy in 15 fractions
39. According to the ASTRO guideline update, what is a preferred dose fractionation schema for whole breast irradiation ?
(1) 40 Gy in 15 fx
(2) 42.5 Gy in 20 fx
(3) 50 Gy in 25 fx
(4) 50.4 Gy in 28 fx
40. A 58-year-old patient with NSCLC presents with two asymptomatic, subcentimeter intracranial lesions consistent with brain metastases. Which radio therapeutic strategy is most appropriate ?
(1) WBRT with opposed laterals
(2) WBRT with hippocampal Avoidance
(3) Stereotactic radiation
(4) Neurosurgical resection with cavity radiation
41. A 62-year-old man is following surgical resection of a 2.6 cm poorly differentiated squamous cell carcinoma of the left oral tongue with modified radical neck dissection, yielding 6 nodes, 2 of which were involved by tumor. All surgical margins were negative, but there was a spread of tumor beyond the capsule in one of the lymph nodes. Which of the following is the most appropriate recommendation ?
(1) Radiation to the site of the primary tumor and the neck
(2) Radiation to the site of the primary tumor and the neck, with concurrent cisplatin chemotherapy
(3) Cisplatin-based combination chemotherapy for 6 cycles
42. Cisplatin has all the following properties except :
(1) It is used as a radiosensitizer with concurrent radiation therapy
(2) It is cell-cycle non-specific
(3) It is similar in efficacy to its isomer, trans-platinum
(4) It causes both inter-strand and intra-strand crosslinking
43. Sorafenib is FDA approved for use in treatment cancers except –
(1) Hepatocellular carcinoma
(2) Thyroid cancer
(3) Pancreatic cancer
(4) Kidney cancer
44. Which of the following is a reasonable possible explanation for the longer survival times for patients treated with TPF in TAX 324 compared with the survival times for patients treated with TPF in TAX 323 ?
(1) TAX 323 was restricted to patients with unresectable disease, Whereas TAX 324 included both patients with resectable disease and patients with unresectable disease
(2) After induction TPF, patients in TAX 324 received radiation therapy with concurrent weekly carboplatin, whereas patients in TAX 323 received radiation therapy only after TPF
(3) In TAX 324, the cisplatin dose was higher than the cisplatin dose used in TAX 323.
(4) All of the above are true.
45. What is the most common side-effect of erlotinib ?