2019 AAPM Annual Meeting
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Session Title: Immunotherapy Killed the IGRT Star
Question 1: Immunotherapy, which uses the body's immune system to fight cancer, includes which categories of therapeutics?
Choice A:Monoclonal antibodies
Choice B:Oncolytic virus therapy
Choice C:T-cell therapy
Choice D:Cancer vaccines
Choice E:All of the above
Question 2: IGRT refers to imaging in the treatment room intended to increase the agreement between the planned and delivered dose by primarily correcting for which component of uncertainty?
Reference:Bujold A1, Craig T, Jaffray D, Dawson LA. Image-guided radiotherapy: has it influenced patient outcomes? Semin Radiat Oncol. 2012 Jan;22(1):50-61. https://dx.doi.org/10.1016/j.semradonc.2011.09.001
Choice A:Organ deformation
Choice B:Respiratory motion
Choice C:Geometric variability
Choice D:Weight loss changes
Question 3: The effectiveness of SBRT to control oligometastases increases with dose.
Reference:Salama JK, Hasselle MD, Chmura SJ, Malik R, Mehta N, Yenice KM, Villaflor VM, Stadler WM, Hoffman PC, Cohen EE, Connell PP, Haraf DJ, Vokes EE, Hellman S, Weichselbaum RR. "Stereotactic body radiotherapy for multisite extracranial oligometastases: final report of a dose escalation trial in patients with 1 to 5 sites of metastatic disease," Cancer. 2012 Jun 1;118(11):2962-70. https://dx.doi.org/10.1002/cncr.26611 McCammon R1, Schefter TE, Gaspar LE, Zaemisch R, Gravdahl D, Kavanagh B. "Observation of a dose-control relationship for lung and liver tumors after stereotactic body radiation therapy." Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):112-8. https://dx.doi.org/10.1016/j.ijrobp.2008.03.062
Choice A:True
Choice B:False
Question 4: How does a larger tumor burden affect T-cell function?
Reference:Huang et al, "T-cell invigoration to tumour burden ratio associated with anti-PD-1 response." Nature. 2017 May 4;545(7652):60-65. https://dx.doi.org/10.1038/nature22079
Choice A:Tumor phenotype becomes too heterogeneous for T-cells
Choice B:By exhausting T-cells that mount a response
Choice C:Because T-cell proliferation rate increases
Question 5: What are the major pathways shown to be induced by SBRT in human tumors?
Reference:Luke et al, "Safety and Clinical Activity of Pembrolizumab and Multisite Stereotactic Body Radiotherapy in Patients With Advanced Solid Tumors," JCO 36(16):1611-1622, 2018. https://doi.org/10.1200/JCO.2017.76.2229 Bhave et al, "Long‐term clinical outcomes and transcriptional analysis following partial and complete tumor SBRT plus pembrolizumab," J Clin Oncol 37, 2019 (suppl 8; abstr 34) https://meetinglibrary.asco.org/record/170428/abstract
Choice A:Type-1 interferon
Choice B:Immune function
Choice C:DNA repair
Choice D:All of the above
Question 6: Which tumors are most likely to respond to immunotherapy?
Reference:Hellmann et al, "Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden," https://www.nejm.org/doi/pdf/10.1056/NEJMoa1801946 Joseph et al, "Baseline Tumor Size Is an Independent Prognostic Factor for Overall Survival in Patients wit
Choice A:Tumors with small volumes
Choice B:Tumors that are PDL‐1 positive
Choice C:Tumor with high mutational burden
Choice D:None of the above
Choice E:All of the above
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