Post-Test Questions

Article 1 (87–91)

1. Which of the following therapies has level I data demonstrating prolonged HPFS when combined with systemic chemotherapy vs. chemotherapy alone?

   • Bland embolization

   • Trans-arterial chemoembolization (cTACE)

   • Drug eluting bead – trans-arterial chemoembolization with irinotecan (DEBIRI)

   • Trans-arterial radioembolization (TARE)

2. Which or the following therapies has level I data demonstrating prolonged OS when utilized alone vs. systemic chemotherapy?

   • Bland embolization

   • Trans-arterial chemoembolization (cTACE)

   • Drug eluting bead – trans-arterial chemoembolization with irinotecan (DEBIRI)

   • Trans-arterial radioembolization (TARE)

3. Care should be taken before performing liver directed therapy in which of the following clinical settings?

   • Prior biliary manipulation

   • ECOG performance status of 0

   • Total bilirubin < 1

   • Treatment naïve patients with hepatic dominant liver metastases

   Article 2 (92–100)

4. Expected response to embolotherapy for intrahepatic cholangiocarcinoma is

   • tumor destruction with complete response on follow up imaging

   • partial tumor necrosis with partial mRECIST response on repeat imaging

   • halting disease progression with stability of tumor burden on imaging

   • cure

5. Important considerations when deciding between TACE and TARE include

   • Quality of life

   • Hospital infrastructure/procedure availability

   • Prior biliary instrumentation

   • All of the above

6. Based on recent meta analyses and systemic reviews, the median overall survival for patients with ICC receiving TACE or TARE is:

   • 3–7 months

   • 8–12 months

   • 12–16 months

   • 17–21 months

   Article 3 (101–108)

7. Transarterial embolization is a good therapeutic approach for liver dominant metastatic neuroendocrine tumors for all of the following reasons, except:

   • Long post-procedure median survival times

   • High rate of hormonal symptom control

   • Technical ease

   • Lack of post-embolization syndrome

8. All of the following are positive attributes of transarterial chemoembolization compared to other transarterial locoregional therapies, EXCEPT

   • High degree of reproducibility

   • Long track record in the LRT of hepatic malignancies

   • Utility in segmental or superselective therapy

   • Straightforward capability for intra-procedure dose fractionation

9. For a solitary metastatic neuroendocrine tumor in the anterior segment of the right hepatic lobe, the optimal transarterial locoregional treatment option would be:

   • Transarterial embolization

   • Transarterial chemoembolization

   • Yttrium-90 radioembolization

   • Any of the above

   Article 4 (109–115)

10. In the setting of transplantation, which of the following statements regarding the role of locoregional therapies is correct?

    • Only RE has been proven to effectively downstage to and bridge patients within Milan criteria for transplantation.

    • Only TACE has been proven to effectively downstage to and bridge patients within Milan criteria for transplantation.

    • RE has been shown to effectively downstage patients to meet Milan criteria for transplantation but has not been proven to bridge patients within Milan criteria to transplantation.

    • TACE has been shown to effectively downstage patients to meet Milan criteria for transplantation but has not been proven to bridge patients within Milan criteria to transplantation.

    • Both RE and TACE have been shown to effectively downstage to and bridge patients within Milan criteria for transplantation.

11. In the treatment of BCLC C (advanced stage) disease, which of the following therapies is supported by level 1 evidence?

    • Conventional transarterial chemoembolization

    • Drug-eluting bead transarterial chemoembolization

    • Sorafenib

    • Radioembolization

12. The concept of “treatment stage migration” is best described as:

    • Utilization of treatment modalities distinct from the first-line recommendation because the firstline treatment modality is not feasible or is not recommended

    • Extrapolation of results for a treatment modality from one BCLC stage to a distinct BCLC stage as supported by level 1 evidence for a therapy in the original BCLC stage

    • Downstaging BCLC intermediate stage patients to BCLC early stage in order to facilitate transplantation

    • Discussion of patient's case before a multidisciplinary tumor board in order to effectively coordinate care

    Article 5 (116–120)

13. The SIRFLOX trial of radioembolization as first-line therapy for metastatic colorectal cancer showed:

    • Superior overall survival in the radioembolization arm

    • Superior progression free survival in the radioembolization arm

    • Superior hepatic progression-free survival in the radioembolization arm

    • Superior progression free survival in the control arm

14. Based on single arm prospective studies, dose reduction of which of the following chemotherapy agents should be considered when treating a patient for radioembolization?

    • Oxaliplatin

    • Irinotecan

    • Fluorouracil

    • Capecitabine

15. The greatest survival advantage for radioembolization is when it is offered with chemotherapy in patients who:

    • Are chemotherapy naïve

    • Have failed first-line chemotherapy

    • Have failed multiple lines of chemotherapy

    • Currently unknown

    Article 6 (121–131)

16. Regarding cryoablation, microwave ablation, and radiofrequency ablation, which of the following is FALSE?

    • A distinct advantage of cryoablation is the easy visualization of the ablation zone in real-time when targeting large soft-tissue components

    • Significant nerve injury is uncommon with radiofrequency ablation due to the slow rate of tissue heating

    • Microwave ablation can produce large ablation zones, but ablation zones are less easily monitored

    • Care should be taken when using ablation probes in sclerotic lesions to avoid probe damage

    • Pre-ablation arterial embolization can be particularly useful in hypervascular tumors to minimize heatsink effect

17. When treating multiple myeloma in the spine, which of the following statements is FALSE?

    • PMMA injection alone is often sufficient for adequate stabilization, pain relief, and tumor control without the need for ablative therapy

    • Prophylactic augmentation of vertebral bodies at high risk of fracture or fracture progression can prevent significant pain and morbidity

    • The Spinal Instability Neoplastic Score (SINS) can be a useful tool in assessing fracture risk associated with metastatic disease

    • Myeloma is considered relatively resistant to radiotherapy and ablation prior to augmentation can significantly improve local tumor control

    • Vertebral augmentation consisting of an initial device implant followed by PMMA can guide cement deposition and minimize cement extravasation

18. Ablation, osteoplasty with or without screw fixation in the pelvis may be a preferred alternative to surgical fixation in metastatic disease of the pelvis for all of the following reasons EXCEPT?

    • Ablation with osteoplasty provides adequate stabilization in the weight-bearing long bones

    • Patients have similar relief of pain, improved function, and decreased recovery time including length of stay in the hospital

    • Chemotherapy and radiation therapy can usually be resumed or started immediately

    • Patients prognosis and life expectancy may not be long enough to warrant major open surgery

    • Surgery depresses the immune system thus potentiating cancer progression

    Article 7 (132–139)

19. The most widely reported imaging criteria for evaluation of tumor response after intra-arterial therapy for liverdominant metastatic breast cancer is:

    • WHO

    • EASL

    • mRECIST

    • RECIST v1.1

    • LI-RADS

20. A 64-year-old woman with breast cancer diagnosed 20 years ago is status post lumpectomy and has stable lung and bone metastases on paclitaxel and bevacizumab. Bilobar liver disease is progressing. Her last dose of bevacizumab was 3 weeks ago. She has previously received tamoxifen, doxorubicin, docetaxel, exemestane, everolimus, navelbine, capecitabine, and gemcitabine. Her ECOG performance status is 0, liver burden is <25%, total serum bilirubin is 0.8, and albumin is 3.4. What is the best approach to arrest progression in the liver?

    • Conventional chemoembolization

    • Whole liver radioembolization

    • Sequential bilobar radioembolization

    • Drug-eluting bead chemoembolization

    • Hepatic arterial infusion chemotherapy

21. What is the median overall survival after intra-arterial for liver metastases from soft tissue sarcomas after progression on a tyrosine kinase inhibitor?

    • 9–14 mo

    • 15–20 mo

    • 20–26 mo

    • 30–40 mo

    • 42–60 mo

    Article 8 (140–144)

22. Which of the following regarding hospice is FALSE?

    • The terms “hospice” and “palliative care” are interchangeable.

    • In order to be eligible for hospice care, a patient must have a life expectancy of under 6 months.

    • Hospice is primarily designed to help patients who are approaching the end of life maintain comfort and remain in their own home for the final phase of life

    • Hospice teams include physicians, nurses, social workers, home health aides, and chaplains

    • All of the above are true.

23. Palliative care should be initiated just prior to hospice care in order to reserve resources needed for end of life care?

    • True

    • False

24. All of the following are used to treat the symptom of nausea and vomiting EXCEPT:

    • Venting gastrostomy

    • Duodenal stent

    • Colonic stent

    • Paracentesis +/− tunneled catheter

    • All of the above are used to treat nausea and vomiting

    Article 9 (145–166)

25. All of the following are examples of thermal ablation EXCEPT:

    • Cryoablation

    • High intensity focused ultrasound

    • Irreversible electroporation

    • Radiofrequency Ablation

    • Microwave Ablation

26. Immunoembolization is indicated as a first line treatment in patients with which type of metastatic cancer

    • Colorectal Adenocarcinoma

    • Invasive Ductal Breast Carcinoma

    • Neuroendocrine Tumor

    • Uveal melanoma

    • Pancreatic Adenocarcinoma

27. In relation to neuroendocrine liver metastases, systemic chemotherapy should be considered first line therapy for:

    • Grade 1 tumor

    • Grade 2 tumor

    • Grade 3 tumor

    • Diffuse pattern of intrahepatic disease

    • Complex pattern of intrahepatic disease

    Article 10 (167–175)

28. The preferred solution for hydrodissection (to decrease risk of injury to adjacent structures) during radiofrequency ablation of small renal masses is:

    • 0.9% normal saline

    • 5% dextrose

    • Lactated Ringers solution

    • Mannitol

29. The current gold-standard treatment for renal tumors less than 3 cm in size is:

    • Cryoablation

    • Radiofrequency ablation

    • Watchful waiting

    • Partial nephrectomy

30. Increasing impedence during a thermal ablation has which of the following effects?

    • Increases deliverable energy for cryoablation.

    • Decreases deliverable energy for microwave ablation.

    • Decreases deliverable energy for radiofrequency ablation.

    • None of the above.

31. When compared to partial nephrectomy, the advantages of thermal ablation include all of the following, EXCEPT

    • Decreased blood loss

    • Faster recovery

    • Improved recurrence-free survival

    • Potential to perform the treatment on an outpatient basis

    Article 11 (176–181)

32. Which of the following is an advantage of lung ablation versus surgery?

    • Lung ablation is more effective than surgery for local tumor control.

    • Lung ablation provides higher survival benefit compared to surgery.

    • Lung ablation is more cost effective and often performed as outpatient.

    • Lung ablation typically requires less imaging follow-up.

33. Which ablation device is generally preferred for mediastinal or chest wall tumors?

    • Radiofrequency ablation

    • Microwave ablation

    • Cryoablation

    • Alcohol ablation

34. Which complication is more commonly seen with cryoablation as compared to RFA or MWA?

    • Pneumothorax

    • Hemorrhage

    • Bronchopleural fistula

    • Nerve injury

    Article 12 (182–186)

35. In terms of clinical response assessment, which endpoint is most useful when dealing with multiple lines of therapy?

    • Overall Survival

    • Progression Free Survival

    • Time to Progression

    • Disease-free survival

36. Opportunities for practice building include which of the following:

    • Participation in multidisciplinary clinics

    • Participation in multidisciplinary tumor boards

    • Direct marketing to potential patients

    • All of the above

37. Social media in the context of a medical practice may be used for all of the following EXCEPT:

    • To develop a professional network

    • Consult other physicians

    • Review patient test results

    • Market a practice

    Article 13 (187–200)

38. The FDA has recently approved two HIFU devices for

    • primary treatment of low-to-intermediate risk localized PCa.

    • use as a primary treatment of localized PCa during clinical trials only.

    • prostate tissue ablation only.

    • salvage therapy of PCa after EBRT failure.

39. MRI thermometry allows for the

    • delivery of therapeutic energy focally at prostate tissue

    • real-time monitoring of temperature at prostate tissue

    • real-time monitoring of thermal dose at prostate tissue

    • both b and c.

40. Which of the following patients would less likely to be included in a clinical trial with therapeutic US?

    • Low-risk, localized prostate cancer with PSA < 10 ng/mL

    • Age 50, prostate volume of 35 cc, and a single index lesion

    • Life expectancy < 5 years, previous history of bladder cancer