| Question 1: Which of the following statement for pediatric radiotherapy is incorrect? |
| Reference: | 1. Key statistics for childhood cancer on American Cancer Society website https://www.cancer.org/cancer/cancer-in-children/key-statistics.html
2. Hawkins M, Brownsdon A, Reulen R. Falling risk of heart disease among survivors of childhood cancer. BMJ 368:m58, 2020. |
| Choice A: | On average, childhood cancer patients have over 80% of 5-year survival rate. |
| Choice B: | Central nervous system tumors are the most common pediatric cancers treated with radiation therapy. |
| Choice C: | Photon therapy is currently the most common modality in pediatric cancer radiotherapy. |
| Choice D: | Treatment techniques for Hodgkin lymphoma have evolved from high dose and large fields to lower dose and more conformal fields. |
| Choice E: | Risk of heart disease among survivors of childhood cancer has not seen any decline since 1970s despite technology advances. |
| Question 2: In pediatric intracranial treatments protons are significantly better than photons in |
| Reference: | Carbonara R, Di Rito A, Monti A, Rubini G, Sardaro A. Proton versus Photon Radiotherapy for Pediatric Central Nervous System Malignancies: A Systematic Review and Meta-Analysis of Dosimetric Comparison Studies. J Oncol. 2019: PMID: 31885580 |
| Choice A: | Target dose conformity |
| Choice B: | Target dose homogeneity and organ at risk dose reduction |
| Choice C: | Achieving standard dose constraints |
| Choice D: | All of the above |
| Question 3: What parameters impact the lateral penumbra of a proton beam? |
| Reference: | Wang D, et al. Impact of spot size on plan quality of spot scanning proton radiosurgery for peripheral brain lesions. Med Phys 41(12): p12170, 2014. |
| Choice A: | Energy |
| Choice B: | Treatment depth |
| Choice C: | Beam line configuration |
| Choice D: | Beam aperture |
| Choice E: | All of above |
| Question 4: The clinical studies that suggest protons are superior to photons for pediatric tumors are: |
| Reference: | 1. Kahalley LS, et al. Superior Intellectual outcomes after proton radiotherapy compared with photon radiotherapy for pediatric medulloblastoma. J Clin Oncol. 38:454-461, 2019.
2. Xiang M, Chang DG, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity modulated or proton beam radiation therapy. Cancer 000:1-3, 2020. doi:10.1002/cncr.32936 |
| Choice A: | Nonexistent |
| Choice B: | Based exclusively on biological modeling |
| Choice C: | Suggestive, but inconclusive |
| Choice D: | Conclusive and unquestionable |
| Question 5: The rationale for treating children with protons: |
| Reference: | Seravalli E, et al. Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European Centers: Analysis on behalf of the SIOP-E-BTG (Radiotherapy working group). Acta Oncol 57: 1240-1249, 2018. |
| Choice A: | Is inconsistent with radiation protection philosophy |
| Choice B: | Is consistent with radiation protection philosophy |
| Choice C: | Has nothing to do with radiation protection philosophy |
| Choice D: | Is impossible because of radiation protection philosophy |
| Question 6: A valid consideration for whether proton plans will generally be better for pediatric patients than photon plans is: |
| Reference: | Glimelius B, Montelius A. Proton beam therapy – Do we need the randomized trials and can we do them? Radiother Oncol 83:105–109, 2007. |
| Choice A: | Protons always reduce the low dose volume which is known to benefit patients. |
| Choice B: | Proton plans will benefit patients even if a photon plan can provide the required PTV coverage without exceeding tolerance doses. |
| Choice C: | Proton plans may benefit the patient when photon plans exceed normal organ dose tolerances. |
| Choice D: | Proton plans will dramatically reduce secondary malignancy risk over photon plans. |
