1) You have been asked to recommend a treatment modality for a patient with chondrosarcoma. Carbon ions, currently available in Germany and Japan, may provide a therapeutic advantage over either IMRT or proton therapy for this disease. Which of the following statements about carbon ion therapy is FALSE?
A. Carbon ions produce better sparing of normal tissues in the entrance region of the beam for a given dose to the tumor in the Bragg peak, than either protons or photons.
B. Carbon ions have a high RBE in the Bragg peak region.
C. There is reduced scattering in both the lateral and longitudinal directions for carbon ions compared to protons.
D. There is a greater variation in radiosensitivity between oxygenated and hypoxic tumor cells using carbon ions compared with photons.
E. PET verification can be used for carbon ion treatment plans.
2) Which of the following statements is TRUE concerning boron neutron capture therapy?
A. The boron-neutron interaction results in pair production.
B. Fast neutrons of approximately 10-20 MeV are required in order to maximize the interaction.
C. Boron interacts with neutrons to produce α particles and lithium ions.
D. Protons may be used in place of neutrons since the interaction with boron is the same.
E. Recoil protons are produced when boron interacts with neutrons.
3) Which of the following statements comparing proton with neutron radiotherapy is TRUE?
A. The LET is higher for protons.
B. More conformal dose distributions can be obtained with neutrons than protons.
C. The OER is lower for neutrons.
D. The α/β ratio is higher for protons.
E. The RBE is higher for protons.
4) Which of the following statements concerning IMRT is CORRECT? IMRT:
A. is expected to result in fewer radiation-induced second cancers since a greater volume of normal tissue is exposed to low radiation doses than in conventional treatment plans.
B. might result in a decreased tumor control probability if the time to deliver each dose fraction becomes sufficiently long as to permit recovery from sublethal damage in the tumor.
C. allows for higher doses to acutely responding normal tissues while decreasing dose to late responding normal tissues.
D. is best if used in a hypofractionation regimen, such as two fractions a week.
E. is useful only when coupled with respiratory gating.
5) Which of the following is a small molecule tyrosine kinase inhibitor?
A. trastuzumab
B. erlotinib
C. bevacizumab
D. sirolimnus
E. cetuximab
6) Which of the following statements is TRUE concerning bortezomib? Bortezomib is:
A. an agent that stimulates ubiquitin-mediated degradation of IκB
B. FDA-approved for use in the treatment of pancreatic cancer
C. a drug that specifically targets EGFR signaling pathways
D. a proteasome inhibitor
E. a monoclonal antibody
7) Which of the following best describes the mechanism of action of the chemotherapeutic agent irinotecan?
A. inhibits ribonucleotide reductase
B. stimulates thymidylate synthase
C. interferes with the action of topoisomerase I
D. inhibits DNA helicases
E. generates DNA crosslinks
8) Sorafenib targets which of the following proteins?
A. p53 (TP53)
B. cyclooxygenase 2
C. RAF1 kinase
D. histone deacetylase
E. DNA-PKcs (PRKDC)
9) Imatinib is a small molecule inhibitor of which protein?
A. p53 (TP53)
B. RAS
C. VEGF (VEGFA)
D. ATM
E. BCR/ABL
10) Which of the following best describes the mechanism of action of tipifarnib?
A. inhibitor of BCR/ABL
B. interferes with PTEN
C. inhibitor of RAD9
D. activator of p53 (TP53)
E. inhibitor of farnesyl transferase
11) Which of the following molecularly-targeted agents is an epidermal growth factor receptor inhibitor?
A. bevacizumab
B. combretastatin
C. imatinib
D. cetuximab
E. rituximab
12) Which of the following pairs of drug and description is CORRECT?
A. glutathione – hypoxic cell cytotoxin
B. nimorazole – most abundant cell sulfhydryl
C. tirapazamine – radioprotector
D. amifostine – bioreductive drug
E. gefitinib – small molecule tyrosine kinase inhibitor
13) Which of the following pairs of a chemotherapeutic agent and its potential target is CORRECT?
A. amsacrine – topoisomerase II
B. topotecan – microtubules
C. bevacizumab – EGFR
D. sunitinib – VEGF
E. 5-fluorouracil – glutathione
14) Multi-drug resistance:
A. generally leads to cross-resistance to radiation
B. can be induced by ionizing radiation
C. can be caused by either an increase in p-glycoprotein, increased drug efflux or elevated levels of glutathione
D. generally results in relatively small changes in sensitivity of cells or tumors to chemotherapy agents
E. results in increased proliferation in normal tissues
15) Which of the following pairs of chemotherapy drugs and the dependence of their toxicity on oxygenation status is INCORRECT?
A. Bleomycin – more toxic under aerated conditions
B. Tirapazamine – more toxic under hypoxic conditions
C. 5-Fluorouracil – no difference in toxicity between aerated and hypoxic conditions
D. Mitomycin C – more toxic under aerated conditions
E. Misonidazole – more toxic under hypoxic conditions
16) Which of the following statements concerning photodynamic therapy is INCORRECT? Photodynamic therapy:
A. reduces tumor burden through direct tumor cell killing rather than indirectly through damage to tumor vasculature
B. is generally used to treat either superficial tumors or those that can be accessed with fiberoptic probes
C. may affect the immune response
D. involves the use of a drug activated by visible light
E. is toxic through the formation of singlet oxygen
17) Which of the following statements concerning hypoxic cell sensitizers and bioreductive drugs is TRUE?
A. One possible reason that clinical trials of hypoxic cell radiosensitizers yielded disappointing results is the dose limitation imposed by severe hypotension that often developed in patients receiving higher doses of the drugs.
B. Bioreductive drugs are synthesized in a pro-drug form that, upon administration, are oxidized and thereby activated to a cytotoxic intermediate.
C. Bioreductive drugs are more toxic to aerobic cells than to hypoxic ones.
D. Clinical trials of nimorazole have yielded results indicating a significant improvement in both local control and overall survival in patients with head and neck cancer treated with this drug and radiotherapy.
18) The enzyme inhibited by 5-fluorouracil that is most closely associated with both its cytotoxic and radiosensitizing effects is:
A. dihydrofolate reductase
B. thymidylate synthase
C. RAD50
D. tyrosine kinase
E. ligase IV
19) Radiosensitization produced by gemcitabine is associated with the inhibition of which of the following enzymes?
A. topoisomerase I
B. DNA-PKcs (PRKDC)
C. DNA polymerase
D. ribonucleotide reductase
E. sphingomyelinase
20) Sulfhydryl radioprotectors reduce radiation-induced toxicity by:
A. preventing the formation of free radicals
B. scavenging free radicals
C. stimulating host immune responses
D. inhibiting ion pair formation
E. increasing intracellular oxygen
21) One mechanism by which celecoxib is thought to cause radiosensitization is through inhibition of:
A. phospholipase C
B. prostaglandins
C. HER2 (ERBB2)
D. NFκB
E. RAF1
22) Which of the following statements concerning amifostine is TRUE?
A. Amifostine is most effective when administered orally rather than by injection.
B. Amifostine’s dose-limiting toxicity is peripheral neuropathy.
C. Amifostine does not readily cross the blood-brain barrier.
D. Maximum radioprotection against acute toxicities is achieved when amifostine is administered after irradiation.
E. Amifostine does not require metabolic activation for its activity as a radioprotector.
23) Cisplatin acts as a radiosensitizer by:
A. inhibiting the production of dTMP
B. interfering with DNA repair
C. inhibiting the proteasome
D. blocking growth factor receptors
E. deacetylating histones
24) Which of the following statements about radiation modifiers is TRUE?
A. Curcumin and genistein inhibit NFκB activity, radiosensitize tumor cells and may radioprotect normal cells.
B. Celecoxib enhances formation of hydroxyl radicals during irradiation, thus increasing the killing of tumor cells.
C. Genistein acts in the cell membrane to inhibit radiation-induced ceramide signaling in normal, but not tumor, cells.
D. Amifostine stimulates ATM and p53 (TP53) activities and radiosensitizes otherwise resistant tumor cells.
E. Alkaline phosphatase at the cell surface converts the pro-drug celecoxib to the active free thiol WR-1065.
