Radiation Oncology Resident 2

The correct answer outlines the specific patients treated in the study (adenocarcinoma of mid or distal esophagus), the treatment arms (surgery +/- neoadjuvant chemorads), and the details of the treatment (5FU and cisplat, 40Gy, 5cm sup/inf margin). The incorrect answers provide variations that do not match the criteria of the Walsh esophageal study.

The correct answer is based on the specific data provided in the question regarding the median survival difference between intention-to-treat and treated patients in the Walsh esophageal trial. The incorrect answers are formulated by altering the numbers while still maintaining the general structure of the correct answer for variation.

In the Walsh trial, the 3-year overall survival (OS) difference between neoadjuvant chemoradiotherapy (CMT) and surgery alone was 32% vs 6%. This highlights the significant impact of neoadjuvant CMT in improving survival outcomes.

The correct answer highlights the major criticisms of the Walsh esophageal trial, focusing on the high operative mortality, protocol violations, and poor 3-year overall survival rate compared to historical controls.

The correct answer describes the specific group of patients (Squamous esophageal) and the treatment arms involving surgery and chemotherapy (CDDP) combined with radiation therapy (split course 37Gy) in the EORTC Bosset esophageal study. The incorrect answers provide scenarios unrelated to the study, such as different cancer types and treatment modalities, making them incorrect choices.

The correct answer mentions that there was no difference in median survival (MS) or 3-year overall survival (OS), but there was an improvement in disease-free survival (DFS) and local control (LC) in the EORTC Bosset trial of surgery +/- chemorads for esophageal SCC.

The correct answer highlights a decrease in local and distant failures with concurrent chemoradiotherapy (CMT) compared to radiotherapy alone, with notable statistics like 5-year overall survival (OS) and median survival duration. The incorrect answers provided variations that either contradict or misrepresent the actual findings of the Herskovic NEJM trial for SCC esophageal cancer.

The RTOG 94-05/INT 0123 esophageal study specifically aimed to compare the outcomes of different radiation therapy doses in combination with chemoradiation in esophageal cancer patients. The study found no difference in survival between the 50.4 Gy and 64.8 Gy doses, but noted higher toxicity with the higher dose.

Gallbladder cancer typically presents with symptoms related to bile duct obstruction and liver dysfunction. These can include jaundice, clay-colored stools, dark urine, abdominal pain, fever, malaise, and other gastrointestinal issues. The Courvosier sign, which is a palpable, non-tender gallbladder, can also be a key indicator of gallbladder cancer.

INT 0130 is the correct prospective trial that specifically looked at post-op RT for colon cancer, as described in the answer. The other trials mentioned either focus on rectal cancer, stage II colon cancer, or adjuvant chemotherapy.

Adjuvant chemotherapy for colon cancer is typically given for T3, T4 or N+ disease to help reduce the risk of cancer recurrence. The commonly used agents include 5-FU, leucovorin, Folfox (combination of oxaliplatin, leucovorin, and 5-FU), and capecitabine. These agents work by targeting rapidly dividing cancer cells and preventing them from growing and spreading.

The retroperitoneal portions of the colon are the dorsal and posterior aspects of ascending and descending colon and flexures, not the sigmoid colon, transverse colon, or cecum.

Stage IIB is the correct stage grouping for T4N0M0 rectal cancer according to the TNM staging system. This stage signifies a tumor that has grown through the rectal wall, but has not spread to nearby lymph nodes or distant organs.

Stage grouping I rectal CA is classified as T1-2, N0, M0. The incorrect answers correspond to different stages based on the TNM classification system for cancer staging.

In the TNM staging system, T4 represents the tumor has grown through the wall of the rectum and N1 indicates 1 to 3 nearby lymph nodes have cancer cells. Therefore, the correct stage grouping for T4N1 rectal CA is Stage IIIB.

The correct answer is 20%. This indicates that 20% of T2 rectal tumors have positive lymph nodes, providing insight into the metastatic potential of these tumors.

The correct answer is 5%. This indicates that out of all T1 rectal tumors, only 5% have positive lymph nodes. Incorrect answers such as 10%, 15%, and 20% provide misleading information and should be avoided in this context.

The correct answer is 65-70%. This indicates that a majority of T3-4 rectal tumors have positive lymph nodes, highlighting the significance of lymph node involvement in these cases.

In rectal cancer staging, N1 refers to 1-3 lymph nodes involved, while N2 indicates the presence of 4 or more lymph nodes with cancer involvement.

The correct answer describes the specific patient population (T3/T4 or N+ rectal CA), treatment arms (preoperative versus postoperative chemoradiation), and the treatment details (50.4Gy radiation plus 5FU chemotherapy) of the German rectal cancer study.

The correct answer reflects the findings of the German rectal study comparing preoperative and postoperative chemoradiotherapy in terms of local recurrence, toxicity, disease-free survival, and overall survival. Option 1 is incorrect as it states the opposite of the findings. Option 2 is also incorrect as it presents a different outcome from what was reported in the study. Option 3 is inaccurate as the study did find differences in local recurrence and toxicity between the two approaches.

Transanal excision alone is typically performed for early-stage rectal tumors that meet specific criteria to ensure complete removal without the need for more extensive surgery or additional treatment. The correct answer outlines the specific characteristics of a tumor that is suitable for transanal excision alone.

For T2 rectal tumors treated with wide local excision, the current standard of care is to follow up with post-operative 5-FU chemotherapy and radiation therapy to a total dosage of 45Gy with a boost of 9Gy to reduce the risk of recurrence and improve outcomes.

Local control rate refers to the likelihood of controlling the tumor within the primary site after treatment. In this case, the correct answer shows the local control rates for each stage of rectal tumors post-treatment. The percentages represent the success rates of local control for T1, T2, and T3 rectal tumors, with higher percentages indicating better control outcomes.

The correct answer is 12%. This percentage represents the proportion of patients who will experience late toxicity requiring colostomy after undergoing wide local excision for rectal cancer.

In coloanal anastomosis, the tumor must be located at least 2cm away from the dentate line to qualify for the procedure. This distance helps ensure proper surgical margins and reduces the risk of recurrence.