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1.Define cell cycle.
2. Define interphase.
3.Define G O phase of the cell cycle.
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4.Describe characteristics of cancer cells in G 0.
5.Describe the Growth Fraction/Mitotic Index
6.Describe the characteristics of the best environment for chemotherapy to work.
7.Why is it often difficult to adequately penetrate a large tumor with adequate concentrations of chemotherapy drugs?
8. What is the general correlation of the size of a tumor and the Growth Fractions?
9.Give 4 reasons the growth rate of a tumor often decreases as the size of the tumor increases.
10.Give the number of cancer cells believed to be present in a tumor that is of the minimal size for clinical detection.
11.Give 2 reasons large tumors may become hypoxic.
12.Give 2 reasons why chemotherapy is often administered with more than one drug.
13.List 3 methods of administering chemotherapy drugs.
14.Describe and give indications for the use of a central line.
15.Define the doubling time of a tumor.
16.What is meant by a tumor being composed of a heterogeneous mass of cancer cells?
17.Larger tumors are typically MORE OR LESS sensitive to radiation and/or chemotherapy?
18.Describe the rate of growth of cancer cells and normal cells on which chemotherapy will have the greatest effect.
19.Describe the common side effects of chemotherapy.
20.What is the potential number of cancer cells in a patient who is in clinical remission?
21.Describe the 3-4 phases of drug testing.
22.Be familiar with specific advanced stage tumors in which chemotherapy is effective.
23.Give the criteria for determing a patient's response to a therapy.
24.List all the alkylating agents.
25.List the toxicities associated with alkylating agents.
26.List 3 drugs commonly known to be radiation sensitizers.
27.Describe a recall reaction.
28. List the 2 drugs known to cause the recall reaction.
29.Which drug is known to have significant lung toxicity?
30.Which 2 drugs are known to have cardiac toxicities?
31.What effect does the use of concurrent chemotherapy and radiation have on acute toxicities?
32.Describe the types of cancer cells in which chemotherapy and radiation should be most effective.
33.Which 2 types of cancer treatment are most frequently local/regional?
34. Give 2 examples of systemic radiation.
35. Give 2 examples of when chemotherapy would likely be used in the treatment of patients. Surgery?
36. What is the current estimate of the percentage of patients being treated for cure with surgery?
37. Define operative mortality.
38. List 3 conditions in which a patient with a technically operable tumor may be medical inoperable.
39. Describe the rationale of prophylactic surgery.
40. Give examples of prophylactic surgery.
41. What is the purpose of palliative surgery?
42. Give examples of palliative surgery.
43. What condition must be met before reconstructive surgery will probably be performed?
44. Describe the characteristics of an en bloc resection?
45. Which 2 factors determine the amount of "normal tissue" margin that is resected around a tumor?
46. Give the typical margins associated with cancer surgery.
47. Give 2 examples of when a solitary metastasis can be resected with a curative aim.
48. What is the benefit of cytoreductive surgery?
49. List 5 potential benefits of surgery.
50. List 5 potential disadvantages of surgery and Radiation.
51. Know the TD 5/5 for all normal tissues
52. Know the toxicity for each organ.
53. Define TD 5/5
54. Define TD 50/5
55. Be prepared to calculate the Absolute Granulocyte Count.
56. Know the normal range for all formed elements of the blood.
57. Describe the potential problems of a depression of each of the formed elements of the blood.
58. Know the approximate values at which point additional radiation treatments may be withheld until the blood values recover.
59. Be able to identify tissues of origin that are highly radiosensitive and tissues of origin that are poorly radiosensitive.
60. Describe the difference in morbidity of a Class I organ versus a Class III organ.
61. List the 7 primary areas of red bone marrow production.
62. Identify the 2 areas that account for the majority of bone marrow development.
63. Describe skin care instructions for patients receiving radiation.
64. Describe instructions for patients receiving radiation to the following areas:breast, chest, pelvis, brain, head & neck.
65. Be prepared to identify tissues of origin and tumors of high radiosensitivity and low radiosensitivity.
66. Define hyper fractionation.
67. Differentiate between the 2 types of hyper fractionation; give indications for the use of each.
68. What is the advantage of regular hyper fractionation vs. accelerated hyper fractionation?
69. Describe the 3 types of brachytherapy.
70. What is the goal of curative attempt radiotherapy?
71. Compare the general dose guidelines of curative attempt and palliative radiotherapy.
72. Why is curative attempt radiotherapy often administered at standard fractionation?
73. Define standard fractionation.
74. Compare typical field volumes for epithelial tumors and sarcomas.
75. Give the 2 factors that determine the tumorcidal dose.
76. Give 2 reasons that larger tumors require larger doses of radiation.
77. 1 Gy= 50 Gy= 1 rad=
78. What is the purpose of low dose pre-operative radiotherapy?
79. Give 2 examples of low dose radiotherapy.
80. Compare the time interval before surgery is done following low-dose and high- dose radiotherapy.
81. Give 2 indications for moderate dose pre-operative radiotherapy.
82. List and explain the disadvantages of pre-operative radiotherapy.
83. Why is pre-operative radiotherapy usually limited to 50 Gy/5 weeks?
84. What is the goal of post-op radiotherapy?
85. List 4 indications for post-operative radiotherapy.
86. Why is the radiation field often larger in a post-op setting as opposed to a pre- op setting?
87. List 4 advantages of post-op radiotherapy.
88. List 6 potential complications of post-op radiotherapy.
89. Differentiate between the 2 general methods of administering radiation.
90. Give 3 potential reasons why surgery and either pre or post-op radiation may be used.
91. What is the advantage of the shrinking field technique?
92. What are 3 guidelines of palliative radiotherapy?
93. List potential dose schedules of palliative radiotherapy.
94. Compare the life expectancy of a patient receiving 2000/1 week and a patient receiving 5000/5 weeks.
95. Give the characteristics of prophylactic radiotherapy.
96. Provide justification for the usual dose schedule in a prophylactic setting.
97. Compare the typical failure pathways for surgery vs. radiation.
98. What is the usual time interval between surgery and the beginning of post-op RT?
99. What is the potential problem if an excessive length of time elapses between surgery and the beginning of RT? How can it be managed?
100. List the 4 "Rs" of radiotherapy, and indicate which affects the tumor control and which affects normal tissue tolerance.
101. Explain how repair and repopulation increase normal tissue tolerance.
102. Explain how redistribution and reoxygenation increase tumor radiosensitivity.
103. Give the 2 ways to improve the TR.
104. Give examples of very positive TRs, radio responsive TRs and very negative TRs.
105. What is the most clinically relevant method of improving the TR.
106. Be prepared to explain how each of the 11 ways to increase normal tissue tolerance works.
107. Be prepared to explain how each of the 11 ways to increase tumor damage works.
108.Be prepared to indentify the TR of specific tumors(size and histology) in specific locations(TD5/5).