| Question 1: For patients re-irradiated for treatment of squamous cell head and neck cancer, at two years from re-irradiation treatment: |
| Reference: | JM Brown. Radiation damage to tumor vasculature initiates a program that promotes tumor recurrence, Int J Radiat Oncol Biol Phys 2020. PMID: 32473180. |
| Choice A: | The risk of progression or death is HIGHER, than the risk of radiation related severe toxicity |
| Choice B: | The risk of progression or death is LOWER, than the risk of radiation related severe toxicity |
| Choice C: | None of the above. |
| Question 2: The Canadian Partnership for Quality in Radiotherapy (CPQR) has developed: |
| Reference: | www.cpqr.ca or www.pcqr.ca |
| Choice A: | A White Paper for radiation treatment nomenclature and dose reporting across Canada |
| Choice B: | A Canadian radiation treatment incident reporting system |
| Choice C: | Guidelines for radiation treatment equipment quality control |
| Choice D: | All of the above |
| Choice E: | None of the above |
| Question 3: Is it necessary to correct for fraction size effects when evaluating cumulative normal tissue doses in the re-irradiation setting? |
| Reference: | Murray LJ, et al. Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review. Radiother Oncol. 2017;125(2):213‐222 |
| Choice A: | No |
| Choice B: | Always |
| Choice C: | Not if re-irradiation uses the same prescribed dose per fraction as the previous treatment |
| Question 4: Which of the following are potential benefits of using SABR for re-irradiation?
A: Sharp dose fall off from target
B: Small treatment margins
C: favorable radiobiology for normal tissue with high dose per fraction |
| Reference: | C. Nieder and J. A. Langendijk (eds.), Re-Irradiation: New Frontiers. Reduced Normal Tissue Doses Through Advanced Technology. Springer 2011 |
| Choice A: | All |
| Choice B: | B and C |
| Choice C: | A and B |
| Question 5: AAPM has a task group report for guidance on reirradiation |
| Reference: | https://www.aapm.org/pubs/reports/default.asp |
| Choice A: | True |
| Choice B: | False |
| Question 6: Which value is necessary to determine how much dose is left to give a normal tissue in a re-irradiation case? |
| Reference: | Paradis KC, Mayo C, Owen D, Spratt DE, Hearn J, Rosen B, Kashani R, Moran J, Tatro DS, Beeler W, Vineberg K, Smith DC, Matuszak MM: The Special Medical Physics Consult Process for Reirradiation Patients. Adv Radiat Oncol 4(4): 559-565, 2019. PM31681862/PMC6817723 |
| Choice A: | the alpha/beta ratio of the structure |
| Choice B: | the number of fractions in the current plan |
| Choice C: | the number of fractions in the original plan |
| Choice D: | the dose limit of the structure |
| Choice E: | all of the above |
| Question 7: Chemotherapy is not used as part of a re-irradiation strategy for pelvic recurrence in anorectal cancer patients |
| Reference: | Results of re-irradiation for pelvic recurrence in anorectal cancer patients.
Park Y, Kim K, Park HJ, Jeong SY, Park KJ, Han SW, Kim TY, Chie EK. Br J Radiol. 2019 May;92(1097):20180794. doi: 10.1259/bjr.20180794. Epub 2019 Mar 29. |
| Choice A: | True |
| Choice B: | False |
| Question 8: Carotid blow out is a toxicity that has been observed as a complication of re-irradiation for which site? |
| Reference: | Carotid Dosimetry and the Risk of Carotid Blowout Syndrome After Reirradiation With Head and Neck Stereotactic Body Radiation Therapy.
Gebhardt BJ, Vargo JA, Ling D, Jones B, Mohney M, Clump DA, Ohr JP, Ferris RL, Heron DE. Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):195-200. doi: 10.1016/j.ijrobp.2017.11.045. Epub 2017
Dionisi F, Fiorica F, D'Angelo E, et al. Organs at risk's tolerance and dose limits for head and neck cancer re-irradiation: A literature review. Oral Oncol. 2019;98:35‐47. doi:10.1016/j.oraloncology.2019.08.017 |
| Choice A: | Head and Neck |
| Choice B: | Spine |
| Choice C: | Prostate |
| Choice D: | Lung |
| Question 9: Toxicities of concern for re-irradiation of lung patients include |
| Reference: | Schlampp I, Rieber J, Adeberg S, et al. Re-irradiation in locally recurrent lung cancer patients. Rebestrahlung bei Lokalrezidiven von Lungenkarzinomen. Strahlenther Onkol. 2019;195(8):725‐733. doi:10.1007/s00066-019-01457-2
Rulach R, Hanna GG, Franks K, McAleese J, Harrow S. Re-irradiation for Locally Recurrent Lung Cancer: Evidence, Risks and Benefits. Clin Oncol (R Coll Radiol). 2018;30(2):101‐109. doi:10.1016/j.clon.2017.11.003 |
| Choice A: | Pneumonitis |
| Choice B: | Blood vessel rupture |
| Choice C: | Fatigue |
| Choice D: | All of the above |
| Question 10: For re-irradiation, some institutions have determined that it is safe to discount the contribution of dose from prior treatments based on months elapsed. (T/F) |
| Reference: | Paradis KC, Mayo C, Owen D, et al. The Special Medical Physics Consult Process for Re-irradiation Patients. Adv Radiat Oncol. 2019;4(4):559‐565. Published 2019 Jun 8. doi:10.1016/j.adro.2019.05.007 |
| Choice A: | True |
| Choice B: | False |
