| Question 1: Which of the following is the major defining characteristic of cancer stem cells? |
| Reference: | Clarke, MF et al. Cancer stem cells - perspectives on current status and future directions: AACR Workshop on cancer stem cells. Cancer Research 2006 66(19);9339-44 |
| Choice A: | Proliferation |
| Choice B: | Self-renewal capacity |
| Choice C: | Radioresistance |
| Choice D: | Hypoxia |
| Question 2: Which of the following is a key finding relating to the cancer stem cell theory of the interaction between ionizing radiation and solid tumors that drive its therapeutic resistance? |
| Reference: | Lagadec et al., Radiation-induced reprogramming of breast cancer cells. Stem Cells, 2012, 30(5):833-844 2012 |
| Choice A: | radiation induces hypoxia of the CSC, and thereby increase its radio-resistance |
| Choice B: | radiation induces reoxygenation of the CSCs in a tumor, resulting in increase of proliferation rates |
| Choice C: | radiation induces reprogramming of non-stem differentiated cancer cells into cancer stem cells, enriching the proliferative capacity and tumorigenicity of tumors |
| Question 3: Which of the following radiobiological models attempt to incorporate the radiosensitivity properties of cancer stem cells? |
| Reference: | Yu et al., Incorporating cancer stem cells in radiation therapy treatment response modeling and the implication in Glioblastoma Multiforme treatment resistance. IJROBP 2015; 91(4):866-75 |
| Choice A: | Linear Quadratic (LQ) model |
| Choice B: | Dual-compartment Linear Quadratic (DLQ) model |
| Choice C: | Universal survival curve (USC) |
| Choice D: | Linear Quadratic Linear (LQL) model |
| Question 4: How do tumor blood vessels compare to the blood vessels in normal healthy tissue? |
| Reference: | HyTEC Vision Paper, Song et al. Biological Principles of Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiation Surgery (SRS): Indirect Cell Death. In-Press. |
| Choice A: | The tumor blood vessels and the normal tissue blood vessels are functionally and structurally similar |
| Choice B: | The tumor blood vessels are generally more radiosensitive than the normal tissue blood vessels |
| Choice C: | The tumor blood vessels are generally more radioresistant than the normal tissue blood vessels |
| Question 5: Animal studies in the 1970s with a high initial dose like 10 Gy per fraction attempting to increase blood flow to overcome hypoxia instead found that: |
| Reference: | Clement JJ, Tanaka N, Song CW. Tumor reoxygenation and postirradiation vascular changes. Radiology. 1978 Jun;127(3):799-803. |
| Choice A: | High-dose irradiation causes vascular damage in tumors, thereby increasing tumor hypoxia |
| Choice B: | High-dose irradiation increases tumor blood perfusion leading to reoxygenation of hypoxic tumor cells |
| Choice C: | Anti-tumor immunity is independent of the tumor vasculatures |
| Question 6: The numbers of clonogenic cells in 1g of tumor are about |
| Reference: | HyTEC Vision Paper, Song et al. Biological Principles of Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiation Surgery (SRS): Indirect Cell Death. In-Press. |
| Choice A: | 100,000 |
| Choice B: | 1,000,000 |
| Choice C: | 100,000,000 |
| Question 7: Biologically effective dose (BED) is best defined as: |
| Reference: | Fowler J. 21 years of Biologically Effective Dose. Br. J. Radiol. 83(991): 554-568 (2010). |
| Choice A: | A physical dose that, if delivered, would produce the same biological effect |
| Choice B: | The total dose in 2-Gy fractions that would give equivalent cell kill as the given schedule |
| Choice C: | A systematic method to derive prescription doses that integrate patient-specific information about tumor and normal tissue biology |
| Choice D: | A model-based (e.g., LQ) estimate of effective biological dose that accounts for total delivered dose, dose fractionation, and tissue radiosensitivity |
| Choice E: | A biologically-weighted dose that corrects for particle RBE |
| Question 8: Which of the following radiotracers is commonly used in Position Emission Tomography (PET) for enhanced detection of tumor hypoxia: |
| Reference: | Kelada OJ, Carlson DJ. Molecular imaging of tumor hypoxia with positron emission tomography. Rad. Res. 181: 335-349 (2014). |
| Choice A: | 18F-Fluorothymidine (FLT) |
| Choice B: | 18F-Fluoromisonidazole (FMISO) |
| Choice C: | 18F-Fludeoxyglucose (FDG) |
| Choice D: | 11C-Choline (CH) |
| Choice E: | 11C-Methionine (MET) |
| Question 9: Which of the following molecular events may be a part of immunogenic cell death: |
| Reference: | Kepp O, Senovilla L, Vitale I et al. Consensus guidelines for the detection of immunogenic cell death. Oncoimmunology 2014. Dec 13;3(9):e955691.
Demaria S, Golden EB, Formenti SC et al. Role of Local Radiation Therapy in Cancer Immunotherapy. JAMA Oncol 2015. Dec1(9):1325-32. |
| Choice A: | cell surface translocation of calreticulin |
| Choice B: | extracellular passive release of high mobility group box 1 (HMGB1) from the nucleus |
| Choice C: | extracellular passive secretion of adenosine triphosphate (ATP) |
| Choice D: | all of the above |
| Question 10: The abscopal effect is: |
| Reference: | Formenti SC, Rudqvist NP, Golden EB et al. Radiotherapy induces responses of lung cancer to CTLA-4 blockade. Nat Med 2018 Dec;24(12):1845-1851. |
| Choice A: | a bystander phenomenon observed in adjacent tissues that are exposed to low doses of irradiation |
| Choice B: | only observed in preclinical models |
| Choice C: | potentially mediated by CD8 T-cells recognizing neoantigens upregulated by radiation |
| Choice D: | the regression of irradiated lesions after exposure to immunotherapy |
