Radiation Oncology In-service Exam Review: GI Cancers

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Radiation Oncology In-service Exam Review: GI Cancers - Quiz

Radiation Oncology In-service exam review: GI cancers


Questions and Answers
  • 1. 

    Which major rectal cancer trial showed an overall survival benefit to pre-op radiation?

    • A.

      German Rectal Cancer Trial (NEJM 2004)

    • B.

      Dutch Colorectal Cancer Group (NEJM 2001)

    • C.

      Swedish Rectal Cancer Trial (NEJM 1997)

    • D.

      GITSG 7175

    Correct Answer
    C. Swedish Rectal Cancer Trial (NEJM 1997)
    Explanation
    Both the German and Dutch trials showed LRR improvements but no OS benefit to pre-op RT. Swedish trial showed OS improvement of 48% vs 58% at 5 years. GITSG evaluated post-op RT vs post-op CRT, which improved OS.

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  • 2. 

    What is the treatment of choice for gastric MALT?

    • A.

      Low dose RT alone

    • B.

      Chemotherapy alone

    • C.

      Antibiotics directed at H. pylori

    • D.

      Surgical resection followed by chemoradiation

    Correct Answer
    C. Antibiotics directed at H. pylori
    Explanation
    The treatment of choice for gastric MALT is antibiotics directed at H. pylori. This is because gastric MALT lymphoma is often associated with H. pylori infection, and eradicating the infection with antibiotics has been shown to lead to remission in many cases. Low dose RT alone, chemotherapy alone, and surgical resection followed by chemoradiation may be considered in certain cases, but antibiotics directed at H. pylori is the preferred initial treatment option.

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  • 3. 

    Via what drainage do rectal cancer metastases reach the liver?

    • A.

      Superior rectal vein

    • B.

      Inferior rectal vein

    • C.

      Middle rectal vein

    • D.

      Inferior mesenteric vein

    Correct Answer
    A. Superior rectal vein
    Explanation
    Rectal cancer metastases can reach the liver through the superior rectal vein. The superior rectal vein drains blood from the rectum and it ultimately joins the portal vein system, which carries blood to the liver. This allows cancer cells from the rectum to travel through the bloodstream and establish metastases in the liver. The other options, such as the inferior rectal vein, middle rectal vein, and inferior mesenteric vein, are not the primary routes for liver metastases in rectal cancer.

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  • 4. 

    What was the chemoradiation used in the pre-op arm of the German Rectal Cancer Study (NEJM 2004)?

    • A.

      50.4 Gy with concurrent Xeloda

    • B.

      50.4 Gy with a 5.4 Gy boost with concurrent 5-FU

    • C.

      54 Gy with concurrent 5-FU

    • D.

      50.4 Gy with concurrent 5-FU

    • E.

      25 Gy in 5 fractions with concurrent 5-FU

    Correct Answer
    D. 50.4 Gy with concurrent 5-FU
    Explanation
    25/5 was used as pre-op treatment in the Duth and Swedish rectal cancer studies; the post-op arm of the German trial included at 5.4 Gy boost.

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  • 5. 

    What is the appropriate superior border of the PA field for a rectal cancer plan?

    • A.

      L2-L3

    • B.

      L5-S1

    • C.

      L4-L5

    • D.

      Top of obturator foramen

    • E.

      L3-L4

    Correct Answer
    B. L5-S1
    Explanation
    PA field: superior: L5/S1; Inferior inferior obturator foramen or 3 cm below tumor; Lateral: 1.5 cm outside pelvic inlet
    Lateral fields: posterior: behind bony sacrum; anterior: posterior pubic symphasis if T3, anterior pubic symphasis if T4

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  • 6. 

    What is the appropriate dosing of concurrent 5-FU when given with RT for rectal cancer?

    • A.

      225 mg/m2 over 24 hours, 7 days per week during RT

    • B.

      150 mg/m2 over 24 hours, 7 days per week during RT

    • C.

      250 mg/m2 over 6 hours, 7 days per week during RT

    • D.

      250 mg/m2 over 12 hours, 5 days per week during RT

    • E.

      225 mg/m2 over 12 hours, 5 days per week during RT

    Correct Answer
    A. 225 mg/m2 over 24 hours, 7 days per week during RT
    Explanation
    The appropriate dosing of concurrent 5-FU when given with RT for rectal cancer is 225 mg/m2 over 24 hours, 7 days per week during RT.

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  • 7. 

    Which of the following was a finding of the UKCCCR anal cancer trial working party (Lancet 1996?

    • A.

      Chemoradation with 5-FU and mitomycin improved 3 year OS from 35 to 48% as compared to RT alone

    • B.

      Chemoradiation with cisplatin and 5-FU improved LC from 36% to 59% as compared to RT alone

    • C.

      Addition of post-op RT after surgery improved OS at 3 years from 35 to 48%

    • D.

      Dose escalation from 45 Gy with 50.4 Gy improved LC from 36% to 59%

    • E.

      Chemoradation with 5-FU and mitomycin improved 3 year LC from 36% to 59% as compared to RT alone

    Correct Answer
    E. Chemoradation with 5-FU and mitomycin improved 3 year LC from 36% to 59% as compared to RT alone
    Explanation
    The correct answer is that chemoradiation with 5-FU and mitomycin improved 3 year LC (local control) from 36% to 59% as compared to radiation therapy alone. This means that the addition of chemotherapy with 5-FU and mitomycin to radiation therapy resulted in a significant improvement in the control of the tumor at the local site. The study found that this combination treatment was more effective in preventing the recurrence or progression of anal cancer compared to radiation therapy alone.

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  • 8. 

    What is Courvoisier's sign?

    • A.

      Palpable tumor nodule at the umbilicus

    • B.

      Palpable gallbladder

    • C.

      Migratory thrombophlebitis

    • D.

      Palpable axillary lymphadenopathy

    Correct Answer
    B. Palpable gallbladder
    Explanation
    Trousseau's sign is migratory thrombophlebitis, sister maty joseph nodule is umbilicus nodule, Irish's node is axillary adenopathy

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  • 9. 

    What was the randomization of the GITSG 91-73 trial for pancreatic cancer?

    • A.

      Surgery alone vs surgery followed by chemoradiation with 54 Gy and concurrent 5-FU

    • B.

      Definitive RT to 54 Gy versus Definitive CRT wtih 54 Gy and concurrent 5-FU

    • C.

      Surgery alone vs surgery followed by chemoradiation with a 40 Gy split course followed by adjuvent gemcitabine

    • D.

      Surgery alone vs surgery followed by chemoradiation with a 40 Gy split course and concurrent 5-FU

    • E.

      Surgery alone vs surgery followed by radiation with a 40 Gy split course

    Correct Answer
    D. Surgery alone vs surgery followed by chemoradiation with a 40 Gy split course and concurrent 5-FU
    Explanation
    The randomization of the GITSG 91-73 trial for pancreatic cancer was comparing surgery alone to surgery followed by chemoradiation with a 40 Gy split course and concurrent 5-FU. This means that patients were randomly assigned to either undergo surgery alone or undergo surgery followed by a combination of radiation therapy with a split course of 40 Gy and concurrent administration of 5-FU chemotherapy. The purpose of this trial was to determine the effectiveness of adding chemoradiation to surgery in the treatment of pancreatic cancer.

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  • 10. 

    What was a major finding of the GITSG 91-73 trial for pancreatic cancer?

    • A.

      Addition of adjuvent CRT with 5-FU and 40 Gy split course to surgery improved 5 yr OS from 5% to 14% in resectable pancreatic cancer

    • B.

      Addition of adjuvent CRT with 5-FU and 40 Gy split course to surgery improved 5 yr LC but had no effect on OS.

    • C.

      Addition of adjuvent RT with a 40 Gy split course to surgery improved LC at 2 years from 22% to 43%

    • D.

      Addition of adjuvent gemcitabine to defintive RT for pancreatic cancer improved 1 year LC from 18% to 32%

    Correct Answer
    A. Addition of adjuvent CRT with 5-FU and 40 Gy split course to surgery improved 5 yr OS from 5% to 14% in resectable pancreatic cancer
    Explanation
    The major finding of the GITSG 91-73 trial for pancreatic cancer was that the addition of adjuvant CRT (chemoradiotherapy) with 5-FU (fluorouracil) and a 40 Gy split course to surgery improved the 5-year overall survival (OS) rate from 5% to 14% in resectable pancreatic cancer. This means that patients who received this treatment had a higher chance of surviving for 5 years compared to those who did not receive the adjuvant CRT.

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  • Current Version
  • Apr 12, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 20, 2009
    Quiz Created by
    Mdaly

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