one deck Flashcards
(500 cards)
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
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
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
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
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
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
7
Q
What two main trials examined the utility of post-operative RT?
A
- PORT metaanalysis2. ANITA
8
Q
CALGB 8433: P/D/R
A
P: locally advanced NSCLCD: RT 60Gy +/- induction cisplatin/vinblastineR: 5yr OS improved with induction chemo
9
Q
RTOG 9804 (DCIS +/- RT) recurrence with and without RT
A
7yr LR 7% without RT and 1% with RT
10
Q
WTF is palifermin
A
human keratinocyte growth factor used to reduce severity of mucositis during H&N RT
11
Q
criteria for stage III multiple myeloma
A
hemoglobin < 8.5 orcalcium >12 orBence Jones >12g/24hr oradvanced lytic lesions
12
Q
risk factors for CNS involvement in ALL
A
mature B-cell immunophenotypeT-cell immunophenotypehigh LOH
13
Q
test for continuous independent variable and continuous dependent variable
A
regression
14
Q
test for categorical independent variable and continuous dependent variable
A
T-test and ANOVA
15
Q
test for categorical independent variable and categorical dependent variable
A
chi square
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%)
17
Q
what infection has an increased incidence during bortezomib treatment?
A
Herpes zoster
18
Q
what criteria are used to define active/symptomatic myeloma?
A
CRABC - elevated calciumR - renal insufficiencyA - anemiaB - bone lesions
19
Q
what was the local recurrence rate on RTOG 9704?
A
28% overall (25% with gem, 30% with 5FU)
20
Q
what cytokine is associated with pneumonitis following lung RT?
A
TGFbeta1
21
Q
what RT dose causes ovarian failure in a 30 year old?
A
14Gy for 30yo(18-20Gy from birth to 10yrs)
22
Q
what is the CTV expansion and dose for APBI using EBRT?
A
1.5cm, 38.5Gy
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)
24
Q
Following RT for a solitary plasmacytoma, how often is skeletal survey obtained?
A
skeletal survey every 9-12 months
25
what is the dose per fraction when using 4 fractions of HDR brachytherapy alone for inoperable endometrial cancer (at 2cm from sources)?
8.5Gy per fraction at 2 cm
26
what percentage of patients with inflammatory breast cancer will present with metastatic disease?
25-30%
27
criteria for stage III Wilms
Positive marginPositive lymph nodesPeritoneal implantsPiecemeal resectionsPillagebioPsy
28
what dose rates define HDR and LDR brachytherapy?
LDR 0.4-2Gy/hrHDR >12Gy/hr
29
what histopathological finding and genetic abberation are associated with AT/RT?
negative INI-1 staining, 22q deletion
30
Burkitt lymphoma mutation
t(8;14)
31
what mutations portent a poor prognosis in neuroblastoma
n-myc amplificationLOH 1p + 11qdiploid DNAincreased telomerase activity
32
what chemotherapy was used in RTOG 9802?
PCV - procarbazine/lomustine/vincristine
33
median survival on Stupp trial for patients with MGMT methylation that received temozolomide and RT
23 months
34
factors included in IPI for non-Hodgkins
Age, Performance status, LDH, Extranodal sites, Stage
35
by what mechanism is EGFR expression level elevated in H and N SCCa?
gene amplification
36
what percentage of RT plans on Z11 utilized high tangents?
50%
37
On the WECARE study, what was the 10 year risk of contralateral breast cancer for BRCA1, BRCA2, and non-carrier?
BRCA1 - 20%BRCA2 - 16%non-carrier - 5%
38
what hormone has the lowest threshold for dysfunction after hypothalamic/pituitary RT?
Growth hormone (only requires 18Gy)
39
what molecular features are characteristic of pediatric anaplastic large cell lymphoma?
CD30 positive (100%), ALK rearrangement (90%)
40
Per QUANTEC, what is the risk of radiation pneumonitis with V20 of 30-35% and MLD of 20-23Gy?
20% risk of pneumonitis
41
indications for adjuvant RT following radical hysterectomy
two of the following:>1/3 stromal invasionLVSItumor >4cm
42
what percentage of solitary plasmacytomas arise in bone?
80% are osseous, 20% are extra-osseous
43
first line TKI for clear cell carcinoma of the kidney
sunitinib
44
reactivation of what virus occurs after liver SBRT?
hepatitis B (hence the reason they start antiviral treatment prior to RT)
45
what are the biomarker profiles for luminal B breast cancer?
ER/PR+, Her2+ER/PR+, Her2-, high Ki-67
46
which subtype of renal cell carcinoma is associated with deletion in chromosome 3p and Von Hippel Lindau disease?
clear cell
47
most common cancer in children <18 months of age?
neuroblastoma
48
what percentage of prostate cancer patients present with high risk disease?
25%
49
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
50
for prostate SBRT, what rectal wall constraints are associated with risk of grade 3+ toxicity?
V50 < 3cc, less than 35% of the circumference receiving 39Gy
51
what was the path CR rate in NSABP R03 comparing preop vs. postop CRT for rectal cancer?
path CR rate 15% (obviously only in preop group)
52
on PORTEC-1, what was the 3 year OS after salvage radiation for patients who relapsed at the vaginal cuff following observation?
3yr OS 73%
53
what is the Siewert classification of a tumor mass centered in the gastric cardia with extension of the gastroesophageal junction?
Siewert type III
54
what constitutes T3 gallblader cancer?
invasion of visceral peritoneum, liver, or ONE adjacent organ
55
what is the N stage for anal cancer with unilateral pelvic side wall and inguinal lymph nodes?
N2
56
what is the recommended dose for ALL patients who have persistent testicular disease after induction chemo?
24Gy
57
what is the most common testicular cancer in men older than 50?
lymphoma
58
what are the 3 most common side effects of cetuximab?
acneiform rash, hypomagnesemia, infusion reaction
59
based on the EBCTCG meta-analysis, what is the 5 year local recurrence rate for stage I breast cancer treated with surgery and radiation?
5yr LR 7%
60
what percentage of craniopharyngioma patients will experience long-term diabetes insipidus?
60%
61
what are the most common breast cancer molecular subtypes associated with BRCA1 and BRCA2?
BRCA1 - triple negative / basal subtypeBRCA2 - luminal A/B
62
what 3 structures can be involved in stage II vulvar cancer?
lower urethra, vagina, anus
63
what structures comprise the CTV for IMRT for IB2 cervical cancer?
GTV, cervix, entire uterus, parametrium, upper half of vagina
64
What criteria makes a patient an ideal candidate for bladder preservation?
unifocal T2-3a tumor <5cm, no extensive CIS, no ureteral obstruction, good bladder capacity and renal function, visibly complete TURBT
65
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
66
following bladder preservation treatment, what percentage of long-term survivors will maintain an intact bladder?
80%
67
where do most ependymomas present in adults?
spine
68
what cell surface antigen is targeted by Zevalin (britumomab tiuxetan)?
CD20
69
what cell surface antigen is targeted by brentuximab?
CD30
70
On ECOG 5194 (DCIS +/- RT), what 2 factors indicated a higher risk of ipsilateral breast event?
nuclear grade, patient age
71
what is the appropriate adjuvant RT field and dose for a child with a 4th ventricular grade III non-metastatic ependymoma status post GTR?
RT to resection bed plus margin to 54-59.4Gy in 30-33fxs
72
what is the risk of conversion of solitary osseous plasmacytoma to multiple myeloma at 10 years? what about non-osseous plasmacytoma?
osseous - 54%non-osseous - 11%
73
what is the CSI dose for a child with persistent CSF involvement after chemotherapy for B-cell ALL?
24Gy
74
what are the indications for adjuvant CRT after radical hysterectomy for cervical cancer?
positive nodes, positive margins, parametrial involvement
75
for breast cancer, how many sentinel nodes are needed to give a 9% false negative rate?
3 nodes (false negative rate is 6% with 4 nodes)
76
what was the concurrent chemotherapy regimen utilized in NSABP R-03?
5-FU / leucovorin
77
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
78
what gastric lymph node stations are removed with a D2 dissection?
left gastric, celiac, common hepatic, splenic hilum, splenic artery
79
what is the most common RT regimen for Graves ophthalmopathy?
20Gy/10fxs
80
what is the most common type of childhood leukemia?
B-cell ALL
81
what subtype is not a classical subtype of Hodgkin Lymphoma and what are the molecular markers for that subtype?
nodular lymphocyte predominant CD15/CD30 negative, CD20/CD45 positive
82
what are the 4 subtypes of classic Hodgkin Lymphoma and what are the characteristic molecular markers?
nodular sclerosing, lymphocyte rich, mixed cellularity, lymphocyte poor CD15/CD30 positive, CD20/CD45 negative
83
what were the inclusion criteria for SWOG 8794 (prostatectomy +/- adjuvant RT)?
SVI, ECE, positive margin
84
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?
5yr vaginal recurrence 1.8% with brachy, 1.6% with EBRT
85
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?
stage I/II - 85%stage III/IV - 71%
86
invasion of what structures constitute stage II urethral cancer?
corpus spongiosumprostateperiurethral muscle
87
on RTOG 9811, what was the 5yr OS for patients with T4N+ anal cancer?
5yr OS 40%
88
what was the complete resection rate and 5yr OS in the SWOG 9416 superior sulcus tumor trial?
complete resection rate 76%5yr OS 44%
89
on GOG 37, what was the 2yr local recurrence rate for patients randomized to RT?
2yr LRR 5%
90
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?
inner 1/3 - 3% risk of nodal involvementouter 1/3 - 11% risk
91
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%
92
what is the TD 5/5 for whole kidney?
23Gy
93
what is the age cutoff used for staging thyroid cancer?
age 45
94
male breast cancer is most commonly associated with what mutation?
BRCA2
95
what is the preferred doublet chemotherapy for unresectable mesothelioma?
cisplatin / pemetrexed (40% response rate)
96
what factors constitute IPI for advanced Hodgkin lymphoma?
stage IVmale sexage > 45albumin < 4hemoglobin < 10.5lymphocyte count < 600
97
what are the indications for whole abdominal radiation with favorable histology Wilms?
SPAR:diffuse SpillagePeritoneal seedingAscitespreoperative Rupture
98
what percentage of patients with urothelial carcinoma of the renal pelvis will also have a urothelial carcinoma of the bladder?
50%
99
per NSABP analysis, what is the 10yr local recurrence rate for patients with T3N0 breast cancer treated with mastectomy and chemotherapy (without PMRT)?
10yr LRR 7%
100
what constitutes T2 cholangiocarcinoma of the distal bile duct?
invasion beyond the wall of the bile duct
101
what constitutes T4 cholangiocarcinoma of the distal bile duct?
involves celiac axis or SMA
102
what tumor marker is used to follow granulosa cell ovarian cancers if elevated at diagnosis?
inhibin
103
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%)
104
what triad of symptoms are associated with classic radiation induced liver disease (RILD)?
anicteric hepatomegalyasciteselevated alk phos
105
for grade II astrocytoma, what is the rate of transformation to high grade glioma?
70%
106
what percentage of CNS germ cell tumors in males occur in the pineal area?
60%
107
what IHC stains help distinguish mesothelioma from adenocarcinoma NSCLC?
calretinin, thrombomodulin
108
at what site do most male urethral cancers occur?
bulbomembranous urethra (60%), penile urethra (35%), prostatic urethra (5%)
109
what constitutes FIGO III fallopian tube cancer?
peritoneal implants outside of the pelvis (there is no FIGO IV by the way)
110
what percentage of penile cancers are HPV positive?
80%
111
what percentage of women with BRCA1 mutation will develop breast cancer and/or ovarian cancer by age 70?
60% will develop breast cancer40% will develop ovarian cancer
112
what is the 2 year rate of pelvic insufficiency fracture after definitive radiation for early stage cervical cancer?
35%
113
what constitutes T3 female urethral cancer?
invasion of vagina or bladder neck
114
what percentage of patients with LS-SCLC by conventional imaging will be upstaged by FDG PET?
10%
115
what is the maximum dose constraint for the spinal cord with 3 fraction SBRT?
18Gy
116
for high risk endometrial cancer, what are the two main options for adjuvant WPRT with brachy boost?
WPRT 45Gy, HDR 6Gy x 3 to surfaceWPRT 50.4Gy, HDR 6Gy x 2 to surface
117
for postop endometrial cancer, what are the 3 main HDR regimens?
6Gy x 5 to surface4Gy x 6 to surface7Gy x 3 to 5mm depth
118
what constitutes T2 hepatocellular carcinoma?
solitary tumor with vascular invasion or multiple tumors <5cm
119
what constitutes S2 testicular cancer?
LDH 1.5 - 10x upper limit of normal rangebHCG 5,000 - 50,000AFP 1,000 - 10,000
120
Langerhans cell histiocytosis is associated with what marker?
CD1a
121
what is the histologic feature of ependymoma?
perivascular psuedorosettes
122
what is the histologic feature of retinoblastoma?
Flexner-Wintersteiner rosettes
123
what is the histologic feature of diffuse astrocytoma?
microcystic changes
124
what is the histologic feature of medulloblastoma?
Homer-Wright rosettes
125
what was the surgery and adjuvant chemotherapy used in the CLASSIC trial?
D2 gastrectomyadjuvant oxaliplatin/capecitabine
126
what is the RT dose for MALT (gastric and orbit)?
30Gy/15fxs
127
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)
128
what are the dose constraints for the duodenum when treating the paraaortics in the setting of GYN cancer?
D2cc < 60GyV55 < 15cc
129
what anatomical portion of the penis is most commonly involved in penile cancer?
glans - 50% (next most common is prepuce/foreskin at 25%)
130
what was the rate of pCR and/or minimal residual disease on SWOG 9416 superior sulcus tumor trial?
56%
131
for pancreatic cancer, what are the classic superior and inferior borders for adjuvant RT?
superior T10/11 interspaceinferior L3/4 interspace(superior border of T11, inferior border of L3)
132
what vertebral bodies correspond with the approximate levels of the celiac axis, SMA, and IMA?
celiac - T12SMA - L1IMA - L3
133
what mutation is associated with favorable prognosis in B-cell ALL?
t(12;21) - TEL/AML1
134
criteria for N2 anal cancer?
unilateral internal iliac and/or unilateral inguinal
135
what are the adjuvant chemo options for patients with pN2 NSGCT?
BEP x 2 cycles or EP x 2 cycles
136
what were the two treatment arms in RTOG 9512 for T2 glottic cancer?
70Gy/35fxs qday vs. 79.2Gy/66fxs BIDno significant difference LC, DFS, or OS
137
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
138
what were the 2 treatment arms in RTOG 8501 Herskovic trial for esophageal cancer?
64Gy/32fxs (RT alone) vs. 50Gy/25fxs with concurrent cis/5FU
139
what constitutes T2 pancreatic cancer?
>2cm in size but confined to the pancreas
140
when treating stage I/II seminoma, what is the renal dose constraint?
D50 < 8Gy
141
per the new guidelines for APBI, what are the cautionary criteria for age, tumor size, and margin status?
age 40 - 49 (with no other risk factors)size 2.1 - 3.0cmmargin < 2mm
142
what was median survival on the CROSS trial?
50 vs 25 months (actually 49 vs 24 but lets not be ridiculous)
143
when should capecitabine be taken when used concurrently with radiation for rectal cancer?
1 hour before treatment
144
in treating with conventional fractionation for NSCLC, what is the appropriate CTV margin for adenocarcinoma and squamous histologies?
adeno - 8mmsquamous - 6mm
145
where is the motor cortex?
precentral gyrus
146
What is the 5-year overall survival for stage I, II, III, and IV oral cavity cancer?
I - 75%II - 55%III - 40%IV - 30%
147
What structures comprise the oral cavity?
lip, alveolar ridge, buccal mucosa, retromolar trigone, floor of mouth, oral tongue
148
What structures comprise the oropharynx?
palatine tonsils (fossa and pillars), soft palate, base of tongue, pharyngeal walls
149
What structures comprise the hypopharynx?
pyriform sinuses, postcricoid area, pharyngeal wall
150
GBM: RT fields and dose
CTV 46Gy - T2 + 2cmCTV 60Gy - T1 post / cavity + 2cm
151
GBM: temozolomide dosing during/after RT
during RT: 75mg/m2 dailyafter RT: 150-200mg/m2 days 1-5 on q28day cycle for 6 months
152
GBM: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses
chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 50Gylenses 7Gy
153
GBM: follow up
MRI one month after RT then ever 3 months thereafter
154
GBM: simulation
supine, mask, fuse preop and postop MRIs
155
GBM: RT options for elderly or poor KPS
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)
156
WHO 3 glioma: RT fields and dose
CTV 5940 - GTV/cavity + T2 flair + 2cm
157
WHO 3 glioma: chemotherapy
PCV: procarbazine, lomustine, vincristinegiven either before or after course of RT, possibly omit if 1p 19q codeletion is present
158
WHO 3 glioma: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses
chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 36Gylenses 5Gy
159
WHO 3 glioma: follow up
MRI one month after RT then ever 3 months thereafter
160
WHO 2 glioma: RT fields and dose
CTV 54Gy - GTV / T2 FLAIR + 2cm
161
Anal T2N0: RT fields and dose
CTV 42 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 50.4 - GTV + anal canal + 2.5cmPTV - 1cm margin
162
Anal T3-4N0: RT fields and dose
CTV 45 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 54 - GTV + anal canal + 2.5cm (consider 60Gy if T4)PTV - 1cm margin
163
Anal N+: doses
45Gy to elective nodal regions50.4Gy to nodal regions with nodes <3cm54Gy to primary and nodal regions with nodes >3cm
164
Anal: chemotherapy
two cycles at a 4 week interval:5FU 1000mg/m2 daily x 4 daysmitomycin 10mg/m2 x 1 day
165
Anal: workup
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
166
Rectal: criteria for WLE
T1, <3 cm, <30% circumference, margins >3mm, within 8 cm of anal verge, grade 1-2, no LVSI/PNI
167
Rectal: RT fields and dose (T3-4 or N+)
CTV 45 - mesorectum, presacrals, internal iliacs, obturatorsCTV 50.4 - tumor/mesorectum + 2cm sup/inf
168
Rectal: 2D fields
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
169
Rectal: chemotherapy
preop with concurrent capecitabine 825mg bid M-Fadjuvant treatment for T3/4 or N+ is FOLFOX x 6 months
170
what are the components of FOLFOX
leucovorin (FOLinic acid)5FUOxaliplatin
171
what are the treatment options for early stage esophageal cancer (Tis, T1a, T1b, T2)?
Tis/T1a - endoscopic resection + ablationT1b - esophagectomyT2 - esophagectomy alone if noncervical, <2cm, well differentiated
172
definition of anal margin
area below anal verge encompassing 6cm of skin around anus, consists of keratinizing epithelum
173
definition of anal verge
area near end of anus where nonkeratinizing epithelium becomes keratinizing epithelium
174
What are the components of MAID chemotherapy?
MESNA, adriamycin, ifosfamide, dacarbazine
175
Pisters trial: P/D/R
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%)
176
What were the local control rates for high grade sarcomas in the Pisters trial?
90% vs. 65%
177
NCI (Yang) trial, low grade portion: P/D/R
P: extremity sarcoma s/p WLED: adjuvant RT (63Gy total) vs. observationR: Local control improved with RT (95% vs. 60%)
178
NCI (Yang) trial, high grade portion: P/D/R
P: extremity sarcoma s/p WLED: adjuvant chemo vs. adjuvant chemo-RTR: Local control improved with RT (100% vs. 75%)
179
What was the chemotherapy regimen used in the NCI (Yang) trial?
doxorubicine, cyclophosphamide
180
NCI (Rosenberg) trial: P/D/R
P: 43 patients with high grade extremity sarcomaD: amputation vs. WLE + adjuvant RT (60-70Gy total)R: equivalent local control, DFS, and OS
181
NCIC (O'Sullivan) trial: P/D/R
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%)
182
What were the rates of wound healing complications in the NCIC (O'Sullivan) trial?
35% vs. 15% (neoadjuvant vs. adjuvant)
183
What were the rates of late fibrosis in the NCIC (O'Sullivan) trial?
31% vs. 48% (neoadjuvant vs. adjuvant)
184
nasopharyngeal cancer CTV structures
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
185
GBM volumes (RTOG)
CTV 46 is T2/FLAIR + 2cm, CTV 60 is contrast enhancing portion or surgical cavity + 2cm
186
RTOG GBM normal structure constraints (spinal cord, brain stem, optic chiasm 3mm PRV, optic nerve 3mm PRV)
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
187
Nasopharyngeal carcinoma T1
tumor confined to nasopharynx or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension
188
Nasopharyngeal carcinoma T2
parapharyngeal extension
189
Nasopharyngeal carcinoma T3
skull base or paranasal sinuses
190
Nasopharyngeal carcinoma T4
intracranial extension, cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space
191
Nasopharyngeal carcinoma N1
unilateral cervical nodes <6cm
192
Nasopharyngeal carcinoma N2
bilateral cervical nodes <6cm
193
Nasopharyngeal carcinoma N3
nodes >6cm or extension to supraclavicular fossa
194
NPC extending into nasal cavity and parapharyngeal space with unilateral node <6cm
T2N1, stage II (T1N1 or T2N0-1)
195
NPC extending to nasal cavity with cervical nodes <6cm
T1N2, stage III (T1-2N2 or T3N0-2)
196
NPC extending to paranasal sinus with no cervical nodes
T3N0, stage III (T1-2N2 or T3N0-2)
197
NPC with skull base invasion and no cervical nodes
T3N0, stage III (T1-2N2 or T3N0-2)
198
NPC with skull base invasion and bilateral cervical nodes <6cm
T3N2, stage III (T1-2N2 or T3N0-2)
199
NPC with cranial nerve involvement and no cervical nodes
T4N0, stage IVA (T4N0-2)
200
NPC confined to nasopharynx with supraclavicular node
T1N3, stage IVB (any T, N3)
201
NPC with distant metastases
stage IVC
202
Nasopharyngeal carcinoma T1
tumor confined to nasopharynx, or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension
203
Nasopharyngeal carcinoma T2
parapharyngeal extension
204
Nasopharyngeal carcinoma T3
invasion of skull base or paranasal sinuses
205
Nasopharyngeal carcinoma T4
intracranial extension, involvement of cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space
206
Nasopharyngeal carcinoma N1
unilateral cervical nodes <6cm
207
Nasopharyngeal carcinoma N2
bilateral cervical nodes <6cm
208
Nasopharyngeal carcinoma N3
nodes >6cm or extension to supraclavicular fossa
209
Oropharynx T1
<2cm
210
Oropharynx T2
2-4cm
211
Oropharynx T3
>4cm or extension to lingual surface of epiglottis
212
Oropharynx T4a
invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible
213
Oropharynx T4b
invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid
214
Head & Neck N1
single ipsilateral node <3cm
215
Head & Neck N2a
single ipsilateral node 3-6cm
216
Head & Neck N2b
multiple ipsilateral nodes
217
Head & Neck N2c
bilateral or contralateral nodes
218
Head & Neck N3
>6cm
219
Lip and oral cavity T1
<2cm
220
Lip and oral cavity T2
2-4cm
221
Lip and oral cavity T3
>4cm
222
Lip and oral cavity T4a
Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin
223
Lip and oral cavity T4b
invades masticator space, pterygoid plates, skull base, or encasing carotid
224
Supraglottic larynx T1
limited to one subsite of supraglottis
225
Supraglottic larynx T2
invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)
226
Supraglottic larynx T3
vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage
227
Supraglottic larynx T4a
invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)
228
Supraglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
229
Glottic larynx T1a
involves one vocal cord (normal mobility)
230
Glottic larynx T1b
involves both vocal cords (normal mobility)
231
Glottic larynx T2
impaired vocal cord mobility or involving supraglottic or subglottic larynx
232
Glottic larynx T3
vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage
233
Glottic larynx T4a
invades outer cortex of thyroid cartilage or tissues beyond larynx
234
Glottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
235
NSCLC T1a
<2cm
236
NSCLC T1b
2-3cm
237
NSCLC T2
3-7cm, involving main bronchus >2cm distal to carina, invades visceral pleura, atelectasis extending to hilar region but not involving entire lung
238
NSCLC T3
>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
NSCLC T4
invades mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or nodules in separate ipsilateral lobes
240
NSCLC N1
ipsilsteral intrapulmonary, peribronchial, or hilar nodes
241
NSCLC N2
ipsilateral mediastinal or subcarinal nodes
242
NSCLC N3
contralateral mediastinal or hilar nodes, scalene or supraclavicular nodes
243
Breast T1mi
<1mm
244
Breast T1a
<0.5cm
245
Breast T1b
0.5-1cm
246
Breast T1c
1-2cm
247
Breast T2
2-5cm
248
Breast T3
>5cm
249
Breast T4a
extension to chest wall not including pectorals muscle adherence/invasion
250
Breast T4b
ulceration, edema / peau d'orange
251
Breast T4c
both T4a and T4b
252
Breast T4d
inflammatory carcinoma
253
Breast cN1
mobile axillary nodes (levels 1-2)
254
Breast cN2a
fixed/matted axillary nodes (levels 1-2)
255
Breast cN2b
internal mammary nodes without axillary nodes
256
Breast cN3a
ipsilateral infraclavicular nodes
257
Breast cN3b
ipsilateral internal mammary AND axillary nodes
258
Breast cN3c
ipsilateral supraclavicular nodes
259
Breast pN1a
1-3 axillary nodes
260
Breast pN2a
4-9 axillary nodes
261
Breast pN3a
10 or more axillary nodes or infraclavicular node involvement (level 3)
262
Esophagus T1a
invades mucosa (lamina propria or muscularis mucosa)
263
Esophagus T1b
invades submucosa
264
Esophagus T2
invades muscularis propria
265
Esophagus T3
invades adventitia
266
Esophagus T4a
Resectable tumor that invades pleura, pericarcium, or diaphragm
267
Esophagus T4b
Unresectable tumor that invades adjacent structures
268
Esophagus N1
1-2 regional nodes
269
Esophagus N2
3-6 regional nodes
270
Esophagus N3
7 or more regional nodes
271
Rectum T1
invades submucosa
272
Rectum T2
invades muscularis propria
273
Rectum T3
invades through muscularis propria into pericolorectal tissue
274
Rectum T4
invades adjacent structures
275
Rectum N1
1-3 nodes
276
Rectum N2a
4-6 nodes
277
Rectum N2b
7 or more nodes
278
Anus T1
<2cm
279
Anus T2
2-5cm
280
Anus T3
>5cm
281
Anus T4
invades adjacent organs
282
Anus N1
perirectal lymph nodes
283
Anus N2
unilateral internal iliac and/or inguinal nodes
284
Anus N3
perirectal AND inguinal nodes, bilateral internal iliac or inguinal nodes
285
Prostate T1a
incidental finding in less than 5% of tissue
286
Prostate T1b
incidental finding in more than 5% of tissue
287
Prostate T1c
tumor identified by needle biopsy (not palpable)
288
Prostate T2a
involves less than half of one lobe
289
Prostate T2b
involves more than half of one lobe
290
Prostate T2c
involves both lobes
291
Prostate T3a
extracapsular extension
292
Prostate T3b
seminal vesical invasion
293
Prostate T4
invasion of other organs/structures
294
Cervix FIGO IA1
depth of invasion <7mm
295
Cervix FIGO IA2
depth of invasion 3-5mm, horizontal spread <7mm
296
Cervix FIGO IB1
clinically visible lesion <4cm
297
Cervix FIGO IB2
clinically visible lesion >4cm
298
Cervix FIGO IIA1
<4cm and involves upper vagina
299
Cervix FIGO IIA2
>4cm and involves upper vagina
300
Cervix FIGO IIB
parametrial invasion
301
Cervix FIGO IIIA
invades lower third of vagina
302
Cervix FIGO IIIB
extends to pelvic wall or causes hydronephrosis and/or nonfunctioning kidney
303
Cervix FIGO IVA
invades mucosa of bladder or rectum and/or extends beyond the true pelvis
304
Cervix: what FIGO stage is regional node involvement?
FIGO IIIB
305
Endometrium FIGO IA
invades less than half of the myometrium
306
Endometrium FIGO IB
invades more than half of the myometrium
307
Endometrium FIGO II
cervical stromal invasion
308
Endometrium FIGO IIIA
involves ovaries or uterine serosa
309
Endometrium FIGO IIIB
involves vagina or parametrium
310
Endometrium FIGO IVA
invades bladder or bowel mucosa
311
Endometrium: what FIGO stage is pelvic node involvement?
FIGO IIIC1
312
Endometrium: what FIGO stage is para-aortic node involvement?
FIGO IIIC2
313
Vulva FIGO IA
<1mm depth of invasion
314
Vulva FIGO IB
>2cm in size OR >1mm depth of invasion
315
Vulva FIGO II
involves distal 1/3 urethra, distal 1/3 vagina, or anus
316
Vulva FIGO IVA
involves upper 2/3 urethra, upper 2/3 vagina, bladder, rectum, or is fixed to pelvic bone
317
Subsites of supraglottic larynx
false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds
318
What are the 5 subsites of the oropharynx?
soft palate, palatine tonsils, tonsillar pillars, base of tongue (lingual tonsils), paryngeal wall
319
1cm BOT tumor with no cervical nodes
T1N0, stage I (T1N0)
320
2.5cm left tonsil tumor with no cervical nodes
T2N0, stage II (T2N0)
321
5cm tumor of soft palate with no cervical nodes
T3N0, stage III (T3 or N1)
322
3cm BOT tumor extending to lingual surface of epiglottis with single 2cm node
T3N1, stage III (T3 or N1)
323
BOT tumor invading the medial pterygoid with single 2cm node
T4aN1, stage IVA (T4a or N2)
324
2cm tumor of left tonsil with 4cm left cervical node
T1N2a, stage IVA (T4a or N2)
325
1cm left tonsil tumor with 1cm right cervical node
T1N2c, stage IVA (T4a or N2)
326
left tonsil tumor invading lateral pterygoid with no cervical nodes
T4bN0, stage IVB (T4b or N3)
327
BOT tumor extending to lingual surface of epiglottis with 7cm cervical node
T3N3, stage IVB (T4b or N3)
328
metastatic oropharyngeal cancer
stage IVC
329
Oropharynx T1
<2cm
330
Oropharynx T2
2-4cm
331
Oropharynx T3
>4cm or extension to lingual surface of epiglottis
332
Oropharynx T4a
invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible
333
Oropharynx T4b
invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid
334
Head & Neck N1
single ipsilateral node <3cm
335
Head & Neck N2a
single ipsilateral node 3-6cm
336
Head & Neck N2b
multiple ipsilateral nodes
337
Head & Neck N2c
bilateral or contralateral nodes
338
Head & Neck N3
>6cm
339
Maxillary sinus T1
tumor limited to mucosa of maxillary sinus WITHOUT bone invasion
340
Maxillary sinus T2
bone invasion (excluding posterior wall)
341
Maxillary sinus T3
invasion of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygod fossa, ethmoid sinuses
342
Maxillary sinus T4a
invasion of anterior orbit, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid sinus, frontal sinus
343
Maxillary sinus T4b
invasion of orbital apex, dura, brain, middle cranial fossa, cranial nerves (excluding V2), nasopharynx, or clivus
344
What are the 8 subsites of the oral cavity?
lips, gingiva, alveolus / alveolar ridge, buccal mucosa, retromolar trigone, hard palate, floor of mouth, oral tongue
345
criteria for stage III head and neck cancer
T3 or N1
346
criteria for stage IVA head and neck cancer
T4a or N2
347
criteria for stage IVB head and neck cancer
T4b or N3
348
Lip and oral cavity T1
<2cm
349
Lip and oral cavity T2
2-4cm
350
Lip and oral cavity T3
>4cm
351
Lip and oral cavity T4a
Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin
352
Lip and oral cavity T4b
invades masticator space, pterygoid plates, skull base, or encasing carotid
353
5 subsites of supraglottic larynx
false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds
354
Supraglottic larynx T1
limited to one subsite of supraglottis
355
Supraglottic larynx T2
invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)
356
Supraglottic larynx T3
vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage
357
Supraglottic larynx T4a
invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)
358
Supraglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
359
Glottic larynx T1a
involves one vocal cord (normal mobility)
360
Glottic larynx T1b
involves both vocal cords (normal mobility)
361
Glottic larynx T2
impaired vocal cord mobility or involving supraglottic or subglottic larynx
362
Glottic larynx T3
vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage
363
Glottic larynx T4a
invades outer cortex of thyroid cartilage or tissues beyond larynx
364
Glottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
365
Subglottic larynx T1
limited to subglottis
366
Subglottic larynx T2
extends to vocal cords with normal or impaired vocal cord mobility
367
Subglottic larynx T3
vocal cord fixation
368
Subglottic larynx T4a
invades cricoid cartilage, thyroid cartilage, or tissues beyond larynx
369
Subglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
370
Hypopharynx T1
<2cm, limited to one subsite of hypopharynx
371
Hypopharynx T2
2-4cm, involves more than one subsite of hypopharynx
372
Hypopharynx T3
>4cm, fixation of hemilarynx, invasion of esophagus
373
Hypopharynx T4a
invades thyroid cartilage, cricoid cartilage, hyoid bone, or thyroid gland
374
Hypopharynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
375
CROSS trial: P/D/R
P: 366 patients with resectable esophageal cancerD: surgery +/- neoadjuvant CRT (carboplatin, paclitaxel, 41.4Gy)R: improved OS with CRT (49mo vs. 24mo)
376
What percentage of patients on the CROSS trial had adeno vs. SCCa?
75% adenocarcinoma23% squamous cell carcinoma2% large cell undifferentiated carcinoma
377
Cross trial:overall path CRadeno path CRSCCa path CR
overall path CR: 29%adeno path CR: 23%SCCa path CR: 49%
378
RTOG 9405 / INT 0123 (Minsky trial): P/D/R
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
RTOG 8501: P/D/R
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
What chemotherapy regimens were used for the following:RTOG 8501RTOG 9405CROSS trial
RTOG 8501: cisplatin/5-FURTOG 9405: cisplatin/5-FUCROSS trial: carboplatin/paclitaxel
381
What radiation doses were used in the following:RTOG 8501RTOG 9405CROSS trial
RTOG 8501: 50Gy with chemo, 64Gy aloneRTOG 9405: 50.4Gy, 64.8Gy (both with concurrent chemo)CROSS trial: 41.4Gy with chemo
382
What are the two main studies supporting RT for DCIS?
NSABP B-17, EBCTCG meta-analysis
383
What studies were included in the EBCTCG meta-analysis for DCIS?
SweDCIS, EORTC, UK/ANZ, NSABP B-17
384
What was the IBTR with and without RT in NSABP B-17?
32% vs. 16%
385
What was the IBTR with and without RT in the EBCTCG meta-analysis for DCIS?
28% vs. 13%
386
What are the two main studies supporting observation following lumpectomy for DCIS?
RTOG 9804, ECOG (Hughes)
387
RTOG 9804: entry criteria and difference in IBTR
low or intermediate grade 3mm, IBTR 6.7% vs. 0.9%
388
ECOG (Hughes): entry criteria
low or intermediate grade 3mm
389
ECOG (Hughes): IBTR by grade and age
low/int grade: 10.5% (7yrs)high grade: 15.3%high grade age 45: 10%
390
Rate of tamoxifen use in RTOG 9804 and ECOG (Hughes)
RTOG 9804 - 62%ECOG (Hughes) - 40%
391
What is the main study supporting the use of tamoxifen in DCIS?
NSABP B-24 (50Gy + TAM 5 years vs. 50Gy alone)
392
NSABP B-24: IBRT
15% vs. 11%
393
What are the two main studies supporting adjuvant RT for early stage breast cancer?
NSABP B-06, EBCTCG meta-analysis
394
NSABP B-06: design
mastectomy vs. lumpectomy vs. lumpectomy + 50Gy, all underwent axillary dissection
395
NSABP B-06: IBTR, OS
IBTR: 39% vs 14%OS: no difference
396
What were the major trials included in the EBCTCG meta-analysis for early stage breast cancer?
NSABP B-06, Milan I, EORTC, Danish, NCI, Gustave-Roussy
397
EBCTCG meta-analysis for early stage breast cancer: 10 year IBTR and BCM (N0 and N+)
IBTR: 35% vs. 19%BCM pN0: 21% vs. 17%BCM pN+: 51% vs. 43%
398
What is the main study supporting adjuvant RT and tamoxifen for early stage breast cancer?
NSABP B-21
399
NSABP B-21: design
TAM vs. TAM + 50Gy vs. placebo + 50Gy
400
NSABP B-21: IBTR
TAM alone: 17%RT alone: 9%TAM + RT: 3%
401
What are the two main studies evaluating boost for early stage breast cancer?
EORTC (Bartelink), Lyon
402
EORTC breast boost trial: design
T1-2, N0-1, s/p lumpectomy and axillary dissection, 50Gy +/- 16Gy boost
403
EORTC breast boost trial: IBTR by age
50yrs: 7% vs 4%
404
Canadian (Whelan) hypofrac trial: design
T1-2 N0 post-lumpectomy, 42.5Gy/16 vs 50Gy/25, no boost
405
START B: design
T1-3, N0-1 post lumpectomy, 40Gy/15 vs 50Gy/25, 61% received 10Gy boost
406
What is the main study support observation following lumpectomy for elderly patients with early stage breast cancer?
CALGB (Hughes)
407
CALGB (Hughes): design
>70yrs, T1N0, ER+, TAM + RT (45Gy + 14Gy boost) vs TAM alone
408
CALGB (Hughes): IBTR 10yrs
IBTR: 10% vs 2%
409
NSABP B-04: design
cN0: radical mastectomy vs. total mastectomy vs. total mastectomy + axillary RTcN+: radical mastectomy vs. total mastectomy + axillary RT
410
NSABP 32: design
SLNBx (with ALND if positive) vs. upfront ALND
411
Z11: design
SLNBx positive: ALND + RT vs. RT alone
412
AMAROS: design
SLNBx positive: ALND vs. RT
413
DBCG 82b/c: high risk criteria
T3-4 or N+
414
DBCG 82b: design
premenopausal patients: CMF + RT vs. CMF alone(cyclophosphamide, methotrexate, 5-FU)
415
DBCG 82c: design
postmenopausal patients
416
EBCTCG meta-analysis PMRT: BCM by nodes (20yrs)
N0: no OS differenceN1: BCM 42% vs. 50%N2+: BCM 70% vs. 80%
417
Patchell I: design
surgery + WBRT vs. biopsy + WBRT
418
Patchell I: median OS
3mo vs. 9mo
419
Patchell I: what percentage of patients were found to not have metastases?
11%
420
Patchell II: design
surgery +/- WBRT (50.4Gy!)
421
Patchell II: brain recurrence
70% vs. 18%
422
RTOG 9508: design
1-3 brain mets, WBRT + SRS boost vs. WBRT alone
423
RTOG 9508: results
SRS boost improved median survival by 1-2 months for patients with single met
424
RTOG 9402: design
WHO grade III glioma, PCV + RT vs. RT alone(procarbazine, CCNU (lomustine), vincristine)
425
RTOG 9402: results
No difference in OS with RT, patients with 1p-19q codeletion MS 14.7 yrs vs. 7.3 yrs for patients without codeletion
426
RTOG 9802: design
WHO grade II glioma, observation for low risk (age
427
RTOG 9802: results
MS 13.3yrs vs. 7.8yrs - addition of PCV to radiation improves survival in high risk WHO grade II glioma
428
EORTC "believers trial": design
WHO grade I-II, adjuvant RT 45Gy vs. 59.4Gy
429
EORTC "believers trial": results
no difference in overall survival or progression free survival with dose escalation
430
EORTC "nonbelievers trial": design
WHO grade I-II, adjuvant RT 54Gy vs. observation
431
EORTC "nonbelievers trial": results
5yr PFS 55% vs. 35%, no difference in OS
432
EORTC, anal cancer (Bartelink): design
RT with concurrent 5FU/mitomycin vs. RT alone
433
EORTC, anal cancer (Bartelink): results
5yr LC 68% vs. 50%colostomy free survival 72% vs. 40%no difference in OS
434
UKCCCR ACT I: design
RT with concurrent 5FU/mitomycin vs. RT alone
435
UKCCCR ACT I: results
chemo improved LC and CFS but no improvement in OS
436
What are the two main studies supporting the addition of chemotherapy to RT for anal cancer?
EORTC (Bartelink), UKCCCR ACT I
437
What are the two main studies evaluating mitomycin vs cisplatin for anal cancer?
ACT II, RTOG 9811
438
ACT II: results
similar toxicity, no difference in LC, CFS, or OS
439
RTOG 9811: results
mitomycin improved 5yr OS (78% vs 71%) and CFS (725 vs 65%)
440
What was the clinical question/answer with RTOG 0529?
anal cancer, when compared to results from RTOG 9811, IMRT results in reduced skin, GI, and heme toxicity
441
CROSS trial: design
surgery alone vs. surgery with neoadjuvant CRT (41.4Gy, carboplatin/paclitaxel)
442
CROSS trial: 5yr OS results
5yr OS 47% vs 34%
443
CROSS trial: pCR rate(s)
pCR 29% (23% for adeno, 49% for SCCa)
444
RTOG 8501: design
esophageal cancer definitive treatment, 64Gy vs. 50Gy + cisplatin/5FU
445
RTOG 8501: 5yr OS
26% vs. 0%
446
RTOG 9405 (Minsky): design
50.4Gy + 5FU/cisplatin vs. 64.8Gy + 5FU/cisplatin
447
RTOG 9405 (Minsky): results
closed early, excess early deaths in dose escalation arm
448
MAGIC trial: design
gastric cancer, surgery alone vs. surgery + pre and post-op ECF chemotherapy(epirubicin, cisplatin, 5FU)
449
What chemo was used in the MAGIC trial?
ECF (epirubicin, cisplatin, 5FU)
450
MAGIC trial: 5yr OS results
5yr OS 36% vs. 23%
451
Intergroup / SWOG gastric cancer study: design
post-op observation vs. 45Gy + 5FU/leucovorin
452
Intergroup / SWOG gastric cancer study: 5yr OS and criticisms
5yr OS 44% vs. 26%, D1 resection in 50%, D2 resection in 10%
453
ARTIST trial: design
gastric cancer s/p surgery with D2 resection, adjuvant capecitabine/cisplatin vs. sequential chemo/RT/chemo
454
ARTIST trial: results
no difference in OS, possibly due to extensive surgical resection (D2)
455
CONKO: design
pancreas s/p resection, observation vs. gemcitabine
456
CONKO: MS results
MS 22mo vs 20mo
457
GITSG resectable pancreas: design
surgery alone vs. surgery + adjuvant RT + 5FU (40Gy split course)
458
GITSG resectable pancreas: MS results
MS 20mo vs. 11mo
459
EORTC resectable pancreas: design
adjuvant observation vs. CRT (40Gy split course, 5FU)
460
EORTC resectable pancreas: results
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
ESPAC-1: design
2x2 factorial design, RT 40Gy, 5FU chemotherapy
462
ESPAC-1: results and criticisms
reduced survival with patients receiving RT, not really randomized, no RT quality assurance, wide range of RT doses used
463
RTOG 9704: design
adjuvant 5FU vs gemcitabine(5FU vs gem -> 50.4Gy with 5FU -> 5FU vs gem)
464
RTOG 9704: results
nonsignificant trend toward improved survival with gemcitabine
465
NEJM FOLFIRINOX vs. gemcitabine for metastatic pancreatic cancer: results
MS 11mo vs 7mo(leucovorin, 5FU, irinotecan, oxaliplatin)
466
Dutch rectal cancer study: design and results
design: preop RT (25Gy/5) + TME vs. TME alone,results: 10yr LR 5% vs 11%
467
Swedish rectal cancer study: design and results
design: preop RT (25Gy/5) + surgery vs. surgery alone (TME not used)results: 13yr OS 38% vs. 30%, LR 9% vs 27%
468
German rectal cancer study: design
preop CRT (50.4Gy, 5FU) vs postop CRT (50.4Gy, 5.4Gy boost, 5FU)
469
German rectal cancer study: results
5yr LR 6% vs. 13% favoring preop
470
Rectal cancer: what was the pCR rate on the German rectal cancer study and NSABP R-04?
German: pCR 8% (concurrent 5FU)NSABP R-04: pCR 21% (concurrent capecitabine)
471
BC2001: design
two randomizations:1. concurrent 5FU/mitomycin vs. no chemo2. standard volume RT vs. reduced high dose volume RT
472
BC2001: results
nonsignificant trend toward improved OS with chemotherapy (48% vs 35%)
473
RTOG meta-analysis for bladder preservation: pCR, 5yr intact bladder, 5yr OS
pCR 69%5yr intact bladder 80%5yr OS 57%
474
seminoma, MRC 18: design and results
PA field, adjuvant 30Gy vs 20Gy, no difference in local control
475
seminoma, MRC 10: design and results
30Gy, dogleg vs. para-aortic field, less toxicity with PA field but slightly increased risk of pelvic relapse
476
Bill-Axelson / Scandinavian study: entry criteria and design
age 10yrs, operable T1-2, PSA
477
Bill-Axelson / Scandinavian study: results
improved survival in men
478
What are the eight dose escalation studies in prostate cancer?
1. MDACC (Pollack)2. Brazil meta-analysis3. GETUG4. Dutch5. MGH PROG6. MRC RT017. Ontario8. Fox Chase
479
MDACC prostate dose escalation: design and results
70Gy vs. 78Gy, failure free survival significantly improved with dose escalation
480
EORTC high risk prostate (Bolla): design
RT 70Gy +/- concurrent and adjuvant ADT (36mos)
481
EORTC high risk prostate (Bolla): 10yr OS results
10yr OS 58% vs 40%
482
RTOG 9202: design
mostly high risk patients, RT 65-70Gy and 4mos NCADT +/- 24mos adjuvant ADT
483
RTOG 9202: results
long term ADT improved LR and CSS; OS improvement in GS 8+ patients
484
GOG 122: population and design
stage III or IV endometrial cancer s/p resection, adjuvant chemo (doxorubicin/cisplatin) vs. WART (30Gy + 15Gy boost)
485
GOG 122: 5yr OS
5yr OS 53% vs 42%
486
GOG 37 (Homesley): population and design
vulvar cancer with positive groin nodes after vulvectomy and lymphadenectomy; pelvic node dissection vs. RT to bilateral pelvic and inguinal nodes
487
GOG 37 (Homesley): 6yr OS
6yr OS 41% vs. 51%
488
GOG 88: population and design
vulvar cancer, clinically N0; vulvectomy + groin dissection vs. vulvectomy + adjuvant inguinal RT (50Gy)
489
GOG 88: results and criticism
LR 19% vs. 0%; 20% received groin dissection and RT, OS 88% vs 63%, RT was prescribed to 3cm and often underdosed
490
GOG 92 (Sedlis): population and design
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
GOG 92 (Sedlis): 10yr LR and OS
10yr LR 21% vs 14%10yr OS 80% vs 71% (NS)
492
GOG 109 (Peters): population and design
stage IA2-IIA s/p radical hysterectomy with positive nodes, positive nodes, OR parametrial invasion; RT +/- chemo (cisplatin, 5FU)
493
GOG 109 (Peters): 4yr OS
4yr OS 71% vs 81%
494
GOG 123 (Keys): population and design
IB2 cervical cancer, RT -> hyst vs. CRT -> hyst
495
GOG 123 (Keys): 3yr OS
3yr OS 74% vs 83%
496
GOG 120: population and design
cervical cancer stage IIB-IVA, definitive CRT with cisplatin vs hydroxyurea vs both
497
GOG 120: results
OS better with weekly cisplatin; less toxicity with cisplatin vs. cisplatin + hydroxyurea
498
RTOG 9001: population and design
cervical cancer stage IIB-IVA, RT vs CRT (cisplatin, 5FU)
499
RTOG 9001: 8yr OS
8yr OS 41% vs 67%
500
RTOG 7920: population, design, results
cervical cancer IB-IIB, WPRT vs EFRT, improved OS with EFRT
