| Question 1: The purpose of the SBRT Working Group (WGSBRT, HyTEC) is: |
| Reference: | This is the charge of the WGSBRT, as presented at AAPM 2014, AAPM 2015, ASTRO 2015, and on the AAPM website: http://aapm.org/org/structure/default.asp?committee_code=WGSBRT |
| Choice A: | To develop policies for implementation of SBRT. |
| Choice B: | To impose adherence to specific fractionation schedules. |
| Choice C: | To specify targeting accuracy for SBRT treatments. |
| Choice D: | To specify dosimetric requirements for SBRT treatments. |
| Choice E: | For hypofractionated and SBRT treatments, to generate reports, including but not limited to, critically surveying the published data regarding: 1. Tumor response. 2. Normal tissue response. 3. Radiobiology of hypofractionated treatments. 4. Clinical rationales for the diverse prescription schemes in current use. 5. Standards for reporting outcome, including endpoints, defining/contouring of target and normal structures, dose definitions. |
| Question 2: The QUANTEC liver report recommends for metastatic liver lesions treated in 3 fractions a mean liver dose limit of .... |
| Reference: | Pan CC, Kavanagh BD, Dawson LA, et al. Radiation-Associated Liver Injury. International Journal of Radiation Oncology*Biology*Physics 2010;76:S94-S100.
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| Choice A: | 5 Gy. |
| Choice B: | 10 Gy . |
| Choice C: | 15 Gy. |
| Choice D: | 30 Gy. |
| Choice E: | None of the above. |
| Question 3: Many studies reported using the following normal liver treatment planning guideline for patients receiving treatment in 3 to 6 fractions... |
| Reference: | Rusthoven KE, Kavanagh BD, Cardenes H, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 2009; 27:1572-1578. |
| Choice A: | ≥1000cc to ≤ 15Gy. |
| Choice B: | ≥700cc to ≤ 15Gy. |
| Choice C: | ≥100cc to ≤ 2 Gy . |
| Choice D: | ≥700cc to ≤ 30 Gy. |
| Choice E: | None of the above. |
| Question 4: Patients with primary liver tumors are more likely to develop RT-associated liver injury than patients with metastatic lesions presumably due to...
|
| Reference: | Rusthoven KE, Kavanagh BD, Cardenes H, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 2009; 27:1572-1578.
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| Choice A: | Prescription dose. |
| Choice B: | Number of fractions. |
| Choice C: | Dose-volume constraints used. |
| Choice D: | Underlying liver disease and lesser volume of healthy liver in patients with primary tumors. |
| Choice E: | Respiratory-induced liver motion. |
| Question 5: The values of the parameters of a model (e.g. TD50, m and n for the LKB model) depend on the following factors: |
| Reference: | Applied Radiobiology, David R. Wigg, Medical Physics Publishing, 2008
Biologically Optimized Radiation Therapy, Anders Brahme, World Scientific, 2014
|
| Choice A: | Organ. |
| Choice B: | Clinical endpoint. (symptom) |
| Choice C: | Scoring system. |
| Choice D: | Fractionation correction. |
| Choice E: | All of the above. |
| Choice F: | None of the above. |
| Question 6: Currently the most important factors to prevent carotid blowout are: |
| Reference: | • Salvage reirradiaton with stereotactic body radiotherapy for locally recurrent head-and-neck tumors, Cengiz M, Özyiğit G, Yazici G, Doğan A, Yildiz F, Zorlu F, Gürkaynak M, Gullu IH, Hosal S, Akyol F, Int J Radiat Oncol Biol Phys, Vol 81, Issue 1, pp 104-109, 2011
• Risk of carotid blowout after reirradiation of the head and neck: a systematic review, McDonald MW, Moore MG, Johnstone PA, Int J Radiat Oncol Biol Phys, Vol 82, Issue 3, pp 1083-1089, 2012
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| Choice A: | Avoid circumferential irradiation. |
| Choice B: | Deliver treatments on non-consecutive days. |
| Choice C: | Minimize the carotid V20 in five fractions to be as small as possible. |
| Choice D: | Minimize Dmax dose. |
| Choice E: | All of the above. |
| Choice F: | Just (a) and (b). |
| Question 7: Based on recent studies involving the use of SBRT in H&N cancer radiotherapy, the following conclusion(s) have been reached... |
| Reference: | • Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx, Teguh DN, Levendag PC, Noever I, van Rooij P, Voet P, van der Est H, Sipkema D, Sewnaik A, Baatenburg de Jong RJ, de la Bije D, Schmitz PI, Int J Radiat Oncol Biol Phys, Vol 72, Issue 4, pp 1119-1127, 2008
• Stereotactic body radiotherapy: a promising treatment option for the boost of oropharyngeal cancers not suitable for brachytherapy: a single-institutional experience, Al-Mamgani A, Tans L, Teguh DN, van Rooij P, Zwijnenburg EM, Levendag PC, Int J Radiat Oncol Biol Phys. Vol 82, Issue 4, 1494-1500, 2012
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| Choice A: | Xerostomia and dysphagia are strongly associated. |
| Choice B: | Xerostomia and dysphagia are not associated. |
| Choice C: | The rates of moderate to severe dysphagia depend on cancer location (e.g. BOT, NP) . |
| Choice D: | The lower mean dose to the superior and middle constrictor muscles by SBRT compared to IMRT has been reflected in a dose response model. |
| Choice E: | All of the above. |
| Choice F: | Just (a) and (c). |
| Question 8: It is recommended that normal liver is defined as: |
| Reference: | • Lee et al., Phase I study of individualized stereotactic body radiotherapy of liver metastases. Journal of clinical oncology 2009;27:1585-1591
• Bujold A, Massey CA, Kim JJ, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. Journal of clinical oncology 2013; JCO. 2012.2044. 1659
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| Choice A: | Liver minus PTV . |
| Choice B: | Liver minus GTV. |
| Choice C: | Whole liver including target volumes. |
| Choice D: | Does not matter if it is liver minus GTV or PTV because in SBRT PTV margins are small. |
| Question 9: Which of the following statements is incorrect? Effective volume approach helps to: |
| Reference: | Dawson et al. Individualized image guided iso-NTCP based liver cancer SBRT. Acta Oncol 2006;45:856-864 |
| Choice A: | Assess risk of toxicity when combined with the reference dose. |
| Choice B: | Assist in selecting the prescription dose so that the risk of toxicity is minimized. |
| Choice C: | Estimate absolute volume of the liver which, in effect, is functional. |
| Choice D: | Stratify patients into risk groups and prescribe dose according to stratification. |
| Question 10: It is recommended that to assess dose-volume effect in liver and to guide planning the following has to be reported: |
| Reference: | Son SH, Choi BO, Ryu MR, et al. Stereotactic body radiotherapy for patients with unresectable primary hepatocellular carcinoma: dose-volumetric parameters predicting the hepatic complication. Int J Radiat Oncol Biol Phys 2010;78:1073-1080.
• Lee et al., Phase I study of individualized stereotactic body radiotherapy of liver metastases. Journal of clinical oncology 2009;27:1585-1591
• Bujold A, Massey CA, Kim JJ, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. Journal of clinical oncology 2013; JCO. 2012.2044. 1659
|
| Choice A: | Dose-volume cut-offs, e.g., V10Gy, percent volume of normal liver receiving at least 10 Gy. |
| Choice B: | Mean liver doses. |
| Choice C: | Doses to absolute threshold volumes, e.g., 700 cc, 800 cc. |
| Choice D: | All of the above. |
