topic wise question of dnb rt theory

1. DNB RADIOTHERAPY QUESTIONS
DR HARIHAR MCS PATNA

2. GLIOBLASTOMA

3. • With regard to malignant supratentorial gliomas:
• a) What are the salient features of the 2016 WHO
classification of malignant gliomas?
• b) What additional molecular / genetic studies
are warranted to treat a grade II astrocytoma
diagnosed using conventional histopathology?
• c) Post-surgical treatment of a grade 3
oligodendroglioma- also state the evidence base.

4. • a) Mention the common brain tumours in:
• i. Supratentorial region
• ii. Infratentorial region
WHO classification of histopathology for central
nervous system tumours.
• b) Imaging, microscopy and molecular genetic
features of oligodendroglioma and its
management.
Describe the doses/drugs and planning technique for
recurrent glioblastoma.

5. • Role of radiotherapy in:
• a) Chromophobe adenoma pituitary
• b) Thymoma
• c) Oligodendroglioma gr. I – II

6. • a) In the 2016 classification of CNS tumors,
what changes have been introduced for the
supra-tentorial glial tumors? b) What is the
current post surgical treatment of grade III
astrocytomas and oligodendrogliomas?
c) Which molecular markers are prognostic
and predictive of treatment response in grade
III astrocytomas and oligodendrogliomas?

7. • Molecular and genetic characteristics of
Glioblastoma Multiforme with regards to: i)
Prognosis ii) MAnagement Indications, dose
schedules and results of chemoradiation
therapy in gliomas.
With respect to pituitary tumors: a) Classify them. b) List presenting features. c) List
advantages/disadvantages of the two principal surgical approaches to resect these
tumors. d) Describe the GTV, CTV and PTV when treating with radiotherapy.

8. • Classify reticulo-endothelial tumours and role
of Radiotherapy in one of them.

9. MEDULLOBLASTOMA
• What are the high-risk factors for
medulloblastoma? b) How does risk-
stratification affect its treatment?

10. • Name the techniques of radiotherapy used for
sellar and suprasellar tumours.
Pathway of circulation of the cerebrospinal
fluid. b) Enumerate clinical situations where
CSF pathway may need to be addressed. c)
Enumerate ways to manage CSF spread.

12. RETINOBLASTOMA
• a) Classify tumours that are seen in the orbit?
• b) What is the hypothesis and genetic basis for
retinoblastoma?
• c) Describe treatment of various stages of
unilateral retinoblastoma.

13. • What are the clinical features of
retinoblastoma? Write a note on bilateral
retinoblastoma.
Classify ophthalmic tumours. b) How will you
plan external radiation therapy for early
retinoblastoma?

14. • Stage-wise management of unilateral and
bilateral retinoblastoma.
Multimodality management of bilateral
retinoblastoma b) Present status of
Radiotherapy in the management of
retinoblastoma and radiation tolerance of
ocular structures.

15. HEAD AND NECK

16. a) What is the presentation in a case of cancer of the
Hypopharynx?
b) What are the investigations done to come to a diagnosis?
c) How does one manage a case of Carcinoma Hypopharynx
with post-cricoid extension and with an N3 node?
d) How does one plan for conventional radiotherapy and
IMRT?
Describe the doses and planning technique for recurrent
neck nodes with primary controlled in a head-neck cancer.

17. • Describe the radiotherapy volume & portals for
irradiation of:
• a) Carcinoma nasopharynx
• b) Unilateral maxilla with orbital margin destruction
• c) Both maxilla with nasal cavity involvement
a) What is meant by conventional fractionation in
Radiotherapy?
b) Outline various altered fractionation schedules that are used
in head and neck cancers.
c) Outline evidence for altered fractionation schedules in head
and neck cancers.

18. • A patient with a T3N1 tonsillar SCC was to be treated
with 70 Gy in 35 fractions over 7 weeks, 5 days a week.
The treatment was interrupted after 5 completed
weeks (50 Gy) for 1 week, to allow healing of mucositis.
a) If the remaining 20 Gy is given over the next two
weeks, what is the predicted loss in tumour control
probability? Explain your calculations and
radiobiological basis. b) What strategy can you adopt to
complete the proposed treatment in a total treatment
time of 7 weeks? Explain why you do not anticipate
worse tumour control or late morbidity?
Discuss recent advances in organ preservation with
special reference to: a) Head & neck cancers

19. • RTOG 90-03 used four different fractionation
regimens to treat headneck cancers, while the
UK CHART trial used two different
fractionation regimens. Drawing from the
results of these two landmark trials explain: a)
Various fractionation schedules that have
been used in head-neck cancers. b) The
radiobiologic principles that may account for
the variable outcomes of patients assigned to
the various arms.

20. • a) Anatomy and lymphatic drainage of larynx.
b) How does this influence radiation planning
) List indications of post operative radiotherapy and post operative chemoradiotherapy in head
& neck cancer. c) Role of brachytherapy in cancer tongue T2N0M0.

21. • a) Rationale of combining chemotherapy with
radiation in head and neck cancers. b) How
would you maintain nutrition of these patients
during chemoradiation?
Rationale, methods and clinical results of
accelerated fractionation schedules in head
and neck cancers.

22. • How will you treat a case of carcinoma
nasopharynx T3N1M0 (WHO type III) in a 45
year old male with history of diabetes for the
last 4 years with good performance score (KPS
– 80) .
Enumerate various skull base tumors. b) How
will you treat skull base chordoma?

23. • Recent concepts in combined modality treatment
of bucco gingival cancers. Syndromes related to
nasopharyngeal cancers Role of concurrent
chemoradiotherapy for locally advanced
oropharyngeal cancer with the available
evidence.
• b) Acute and late toxicities of chemoradiotherapy
and how to minimize them.
• c) Role of targeted therapy.

25. THYROID
• Characteristics and the role of radio-isotopes
in the management of thyroid carcinoma.

26. SALIVARY GLAND TUMOUR
• a) Classify salivary gland tumors. b) List the
indications of radiotherapy in carcinoma
parotid gland. c) Radiotherapy technique,
dose and side effects for carcinoma of parotid
gland?
Select any one disease of reticulo endothelial
system & describe the role of radiotherapy as
an adjunct to other modes of therapy.

27. ESOPHAGUS
• a) What are the signs and symptoms of a patient of
carcinoma esophagus?
• b) How will you triage a patient with carcinoma of the
esophagus?
• c) What is the added value of an FDG PET-CT in a patient
• with:
• 1. No evident metastasis on CECT Thorax-abdomen &
pelvis.
• 2. Solitary liver metastasis on ultrasound of the abdomen
• d) Management of infra-carinal squamous carcinoma of the
esophagus with tri-modality treatment.

28. • ) A 50 year old lady has a newly diagnosed
esophageal cancer extending from 30 to 35cm
(GE junction at 40 cm).What is the role of
endoscopic ultrasound and PETCT Scan in this
patient? b) Treatment algorithm in the
management of the patient.
Role of:
a) EBRT in carcinoma oesophagus
b) Chemoradiotherapy in carcinoma oesophagus
c) Brachytherapy in carcinoma oesophagus

30. LUNG

31. • a) Enumerate the technical steps of Stereotactic
Body Radiotherapy (SBRT) in a flowchart. b)
When is SBRT used in lung cancers? c) What T
and N stage lung cancers are suitable for SBRT? d)
Strategies for manpaging motion in SBRT for lung
tumours.
a) What is the indication of SBRT in lung cancer?
b) How does it compare stage for stage with surgery?
c) Describe the steps in the planning and execution of the
treatment.
d) What is the current status of SBRT in lung cancer?

32. • a) Role of radiotherapy in small cell carcinoma
lung, b) Technique of radiotherapy and doses
in small cell carcinoma lung, and c) Tolerance
doses of organs at risk.
Multimodal approach in the management of
inoperable lung cancers.

33. • Management of a case of superior mediastinal
syndrome.
What is radiation tolerance of lung? b) Acute
and late effects of radiation therapy on lung
tissue.
Consequences of radiation on lung and how
would you manage them.

34. • ) Role of radiotherapy in management of a
stage III B non small cell lung cancer.
Various investigative modalities used for the
evaluation of mediastinal nodes in lung
cancer.
• b) Role of stereotactic radiotherapy in early
stage lung cancer.

35. • Mention the various predictive and prognostic
molecular biomarkers for non small cell
carcinoma.
• b) Role of targeted therapies in the
management of locally advanced and
metastatic non small cell carcinoma

36. • Combined modality management in a case of
Non small cell carcinoma lung of left superior
sulcus T3N0M0.
• b) Radiotherapeutic techniques, dose
constraints to the organs at risk and
management of tumor motion.

37. Renal lump
• A 40 year male presents with a complaint of
hematuria and his CT scan shows a left renal
mass with a renal vein thrombus and poorly
functioning left kidney. a) What other
investigation will you do and why? b) What
treatment will you suggest and why? c) A year
later, the patient has extensive bone and lung
metastasis. How will you treat the patient?

39. NUROBLASTOMA
• Indications of radiotherapy, techniques of
treatment planning and the long term
sequelae of treatment in Neuroblastoma

40. LYMPHOMA
• What is the role of PET-CT in Hodgkin’s
lymphoma? Explain how the findings modify
treatment.
Histological classification of :
a) Hodgkin’s lymphoma
b) Non Hodgkin’s lymphoma

41. • Staging work up of CNS lymphoma c) Evidence
for multimodality treatment and its benefit
over radiotherapy alone.
Histopathological classification of Non-
Hodgkin’s Lymphoma.

42. • Pathological classification of Hogkin’s
lymphoma.
• b) Various chemotherapeutic drug
combinations used in the current
management of Hogkin’s lymphoma.
• c) Role of radiotherapy in the management of
favourable prognosis Stage I to II A classic
Hodgkin’s lymphoma

43. BREAST
Evidence base and rationale for the frequency and
investigations during follow-up of a treated patient of early
breast cancer.

44. • An 80-year-old lady is referred to you with a painless small
• lump in the outer quadrant of her left breast which on a
core biopsy is a ductal adenocarcinoma, ER and PR positive
and HER 2 neu negative.
• a) What further will you ask in history and what will you
• examine and why?
• b) What investigations will you order and why?
• c) Ultrasound abdomen and a subsequent needle cytology
shows a solitary liver metastasis - what will be your
counselling advice in regard to further investigation and
treatment and why?

45. • Oophorectomy in premenopausal breast
cancer
In breast cancer radiotherapy, write notes on:
a) Present status of irradiation of axilla
b) Partial versus whole breast irradiation
c) Hypofractionated versus conventional irradiation
d) Prone versus supine patient position
e) Electrons versus photons

46. • a) Techniques of post-mastectomy external
radiation. b) How are the adjacent fields
matched?
a) Partial breast irradiation: Rationale, Techniques & results

47. • a) Name the features associated with a known
genetic predisposition to breast carcinoma. b)
Enumerate the components of risk/benefit
assessment and counseling in breast cancer
risk reduction. c) Define cancer related
fatigue, its evaluation and management.

48. • Molecular grouping of breast cancer and its
relevance in choosing the therapy for breast
cancer.
What is APBI (Accelerated Partial Breast
Irradiation)? b) What are its indications? c)
What are the methods that have been used in
literature to deliver APBI?

49. • Rationale of using hormone therapy in breast
cancers. b) What are its indications? c) Role of
Anastrazole in post menopausal breast cancers.
Rationale and classification of hormone
therapeutic agents in the management of
carcinoma breast.
• b) Present day role and methods of ovarian
suppression in carcinoma breast. .
• c) What do you understand by
primary/secondary/tertiary
• ovarian function intervention?

50. • Relevance of the anatomical components in
the planning of radiotherapy to the breast.
• b) Radiotherapy techniques relevant in the
planning for a post left sided breast
conservation radiotherapy for a 35 year old
lady with Carcinoma breast T2N1Mo

51. PANCREAS STOMACH
A 50-year-old male, with no major co-morbidities is diagnosed
to have an adenocarcinoma of the gastroesophageal junction
with its epicenter 2cm in the cardia.
a) Describe the Siewert classification of such tumours.
b) The patient has severe dysphagia - what should be the first
intervention?
c) Disease is clinically T3N0M0 – outline further treatment
strategies.

52. • Radiotherapeutic and chemotherapeutic
modalities available for management in
hepatic oligometastasis
. a) Indications of radiotherapy for pancreatic cancer. b) Intensity Modulated
Radiotherapy (IMRT) technique for carcinoma pancreas – volume delineation, dose,
Organs at Risk (OAR) and dose constraints.

53. SKIN
• a) What is mycosis fungoides? b) Role,
technique and results of radiation in mycosis
fungoides.
How would you treat a 2x2cm basal cell
carcinoma of face with Electrons?

55. WILMS TUMOUR NEPHROBLASTOMA
a) Role of radiotherapy in management of Wilms’ tumour?
b) How does one plan and manage a patient of non-metastatic
Wilms’ tumour post-surgery?
c) What are the side effects of the treatment?

56. • With regard to Wilm’s tumor, write the: a)
Staging b) Treatment algorithm based on risk
stratification. b) Role of RT in management of
Wilms’ tumor

57. PNET EWINGS SARCOMA
a) What are the tumours seen in different parts of a long bone?
b) What are the aims of treatment in a case of Ewing’s tumour
of the bone?
c) Discuss the role of chemotherapy and radiotherapy in its
management.
d) What are radiation portals and doses used?

58. • a) What are the principles of limb salvage in
patients with osteosarcoma? What are the
contraindications? b) Chemotherapy and
radiotherapy schedules used in such patients.
Discuss recent advances in organ preservation with
special reference to
a) Sarcoma of extremity

59. • a) Name the tumours arising from metaphysis
and diaphysis. b) Role of the following imaging
in Ewing’s sarcoma: i) Plain X-ray, ii) MRI scan
iii) PET-CT scan c) Immunohistochemistry tests
in histopathologic diagnosis of Ewing’s
sarcoma.

60. • Indications, dose schedules and results of
radiation therapy in osteogenic sarcoma.
Diagnostic evaluation, staging and the role of
multimodality therapy of osteosarcoma of the
femur

61. SOFT TISSUE SARCOMA
• a) Enumerate small round cell tumours.
• b) What is the pathological and immunological
basis of diagnosis of small round cell tumours?
• c) Discuss the diagnosis and management of
pelvic rhabdomyosarcoma in children.

62. • Types, different prognostic factors and
chemotherapeutic agents used in
rhabdomyosarcoma a) Staging of soft tissue
sarcoma of extremity. b) Pre-operative versus
post-operative radiotherapy for soft tissue
sarcoma. c) Role of brachytherapy in soft
tissue sarcoma of extremity. coma

63. • Indications, technique & results of
Radiotherapy in a case of soft tissue sarcoma
involving thigh.

64. COLON RECTUM ANAL CANAL
With regard to cancer of the anal canal:
a) What are the common cancers seen?
b) Concurrent chemo-radiotherapy in the management of a
squamous cell carcinoma.
c) Describe radiation portals and dose schedules used.
d) Describe the chemotherapy used and its dosing and
sequence.

65. • a) Compare preoperative versus postoperative
radiation in locally advanced rectal cancer.
• b) Compare long versus short course
preoperative radiotherapy in rectal cancer.
• c) Radiotherapy versus chemoradiotherapy in
rectal cancer

66. • Operable, but locally advanced rectal cancers
have been preoperatively treated by short
course RT, with or without chemotherapy and
long course RT, with chemotherapy.
a) Write down the fractionation schedules and
chemotherapeutic agents used in the above
schedules. b) How are the pCR and R-O
resection rates obtained? c) What is the data
on loco-regional control and survival with the
above regimens?

67. • Indications, dose schedules, technique and
results of preoperative radiation therapy in Ca
Rectum. Treatment of stage III rectal
carcinoma in a 55 year old male.
Compare the role of preoperative versus
postoperative chemoradiotherapy in locally
advanced carcinoma rectum with regard to
rationale, advantages & disadvantages, and
evidence from important trials.

68. • Role of chemotherapy in the management of
carcinoma anal canal with regard to
indications, chemotherapeutic agents,
mechanism of action, side effects and
evidence from important trials.

69. BLADDER
• A 45 year old lady has a T3N0M0 muscle
invasive transitional cell carcinoma of the
urinary bladder. What is her treatment
options with regard to: a) Surgery. b) Bladder
Preservation Protocol.
Management of:
a) Superficial bladder cancer
b) Muscle invasive bladder cancer

70. • Indications of chemoradiation in urinary
bladder cancer. b) Enumerate radiation
techniques and fields. ) Place of radiation
therapy in cancer of urinary bladder. b) Recent
report on novel interventions in its treatment.

71. • How will you work up a case of suspected
carcinoma of the urinary bladder?
• b) Multimodality approach in a case of muscle
invasive urethelial carcinoma bladder T2N0M0

72. PROSTATE
You wish to treat a patient with adenocarcinoma of prostate with seminal vesicle invasion, but
no pelvic lymphadenopathy by radiation therapy. a) List organs at risk, delineation landmarks
and tolerance doses that will be co-incidentally irradiated. b) List methods to reduce doses to
the above organs at risk.

73. • What is Gleason’s Score in Carcinoma
prostate? b) Risk stratification in carcinoma
prostate
Explain the importance of Prostate Specific Antigen in diagnosis and treatment of
carcinoma prostate.

74. TESTIS
a) How are testicular tumours classified?
b) Staging of testicular tumours.
c) Management of a patient with Stage II non-seminomatous
germ cell tumour of the testis.
How do you keep a patient of testicular NSGCT stage I on surveillance? What are
the poor prognostic factors?

75. • Radiotherapy technique and dose for treating
stage IIA seminoma. c) Prognostic factors of
non-seminomatous germ cell tumour.
How would you treat stage I seminoma of
testes? Describe the radiation portals and
dose schedule?

76. • Diagnostic workup in a case of suspected
testicular mass.
• c) Staging classification of testicular cancer
and management of a case of pure seminoma
Stage II B.

77. OVARY
• a) How are ovarian tumours classified by
WHO? What are the tumours with good
prognosis?
Classify ovarian tumours with regards to its
pathological presentations.

79. CERVIX
• Radiotherapy in carcinoma cervix:
• a) Elective para-aortic irradiation of lymph
nodes: role, dose, portals
• b) Brachytherapy versus IMRT boost: Evidence
• c) EBRT portals of pelvic irradiation

80. • a) Current status of neoadjuvant
chemotherapy in carcinoma cervix.
• b) What is radical trachelectomy?
• c) What basic fundamentals should be taken
into consideration while planning a patient for
radiotherapy?

81. • Enumerate the types of radiation fields for all
kinds of presentation or stages of cancer of
uterine cervix. b) Dose prescription for two of
them.
How will you treat a pregnant woman
diagnosed with stage IB cancer cervix during
her pregnancy?
a) What are the radiological investigations recommended by FIGO for carcinoma
cervix and why? b) What is the use of CT scan and MRI in this disease?

82. • Outline the treatment of a 75 year old female
with non bulky stage IIIB uterine cervical
cancer. Modern approach in para aortic
radiation in gynecological malignancies on the
basis of evidence available in Literature.

83. • Role of radiotherapy in the management of
early stage cancer cervix and indications for
post operative adjuvant treatment.
• c) Management of a 40 year old lady Stage IB,
with post operative squamous cell carcinoma
with positive pelvic and para aortic nodes.

84. VULVA
• a) List the risk factors of carcinoma vulva. b)
What are the indications of post-operative
radiation in carcinoma vulva? c) Techniques of
radiotherapy in carcinoma vulva. d)
Radiotherapy dose and dose limiting
structures in carcinoma vulva.

85. endometrium
• a) Latest FIGO staging system for cancer of
endometrium b) What is the role of radiation
in Stage I Ca endometrium
Classify endometrial tumours with regards to
prognosis and therapeutic outcomes.

86. • Histopathological classification of Carcinoma
Endometrium.
• b) Staging of endometrial carcinoma.
• c) Management options for a post operative
endometrial carcinoma Stage IIIC2 in a 62 year
old lady with Type II diabetes and obesity.

88. BRACHY THERAPY

89. • b) ICRU-89 volumes for image based
brachytherapy in cancer cervix.
a) Properties of an ideal brachytherapy source.
b) Why were radium substitutes required?
c) How are dose rates in brachytherapy binned together?
d) Compare HDR with LDR brachytherapy and the rational to
use these.

90. a) What are the radio-isotopes commonly used in
teletherapy? Give reasoning.
b) What are the radio-isotopes commonly used in
brachytherapy. Give reasoning.
c) What are the current recommendations of image
guided brachytherapy?
d) Enumerate the advantages & disadvantages of
interstitial versus intracavitary irradiation in carcinoma
cervix.

91. • a) What are the various dosimetric systems
used for interstitial brachytherapy? b) What
are the rules of Paris Technique? Draw neat
diagrams to explain the rules.

92. • a) Low Dose Rate (LDR) and High Dose Rate
(HDR) brachytherapy techniques of carcinoma
prostate with radiobiological principles. b) The
properties of radioisotopes used in LDR and
HDR. c) Late complications of both the
techniques.

93. • Isotopes in use for genitorurinary
brachytherapy. ) Various gynecological
brachytherapy approaches in all stages of
disease presentation. b) Describe any one of
the best brachytherapy approach & why you
chose so.

94. • Isotopes for high dose rate brachytherapy in
current practice with advantages and
disadvantages of each.
• b) Role of brachytherapy in:
• i. Carcinoma oropharynx
• ii. Carcinoma anal canal

95. Multiple myeloma plasmacytoma
• a) Initial diagnostic work up of a suspected
multipleb myeloma
• b) Mention major & minor diagnostic and
prognostic criteria.
• c) Management of a solitary plasmacytoma

96. • a) Enumerate the laboratory and radiological
investigations required for the staging of
multiple myeloma. b) Give details of the likely
abnormalities that may be detected and how
they determine the stage of disease?

97. • Indications of treatment, staging system and
chemotherapy schedule of choice in multiple
myeloma.
Diagnostic work up and staging system for
multiple myeloma.
• b) Management of a clinical solitary lesion
involving the sphenoid bone, labeled as
plasmacytoma

98. ELECTRONE THERAPY
a) Enumerate the clinical settings in which electrons are used. b) What are the methods for field
shaping in electron beam therapy? c) Give one example where internal shielding is used in
electron therapy with rationale. d) Mention advantages and disadvantages of field matching in
the following: i) Photon-Electron field ii) Electron-Electron field

99. • Process of treatment planning with electrons.
b) Enumerate the sites where it is regularly
used, if available. ) What are the advantages
and indications of electron beam therapy?
Total skin electron therapy with regard to
indications, radiotherapeutic technique and
complications

100. • Physical properties of electron beams.
• b) Clinical applications of electron beams.

101. PROTONE THERAPY
• With regard to proton therapy:
• a) Rationale and radiobiological basis for proton beam
therapy.
• b) Name the two ways in which the beam spreading is
done.
• c) What are the dose calculation algorithms used?
• d) What are the potential application of Proton Beam
Therapy in clinical practice?
• e) Clinical evidence for Proton Therapy with regard to
efficacy and toxicity and comparative effectiveness.

102. • a) What is Bragg peak? b) How is Bragg peak
converted to useful radiotherapy beam? c) List
the advantages of using such a technique for
treatment. d) Bragg peak is a double edged
sword. Why?
Structure and function of a proton beam
accelerator.
• b) Physical characteristics of a proton beam and
the current clinical applications of proton beams.

103. NEUTRONE THERAPY
• What are the advantages and disadvantages
of fast neutron radiotherapy? Give
appropriate clinical examples.

104. PDT
• Photodynamic therapy

105. HYPERTHERMIA
Discuss hyperthermia with regard to:
a) Methods of local heating
b) Mechanism of hyperthermia
c) Thermotolerance
d) Hyperthermia and its interaction with chemotherapeutic
agents
e) Human applications – any 2 sites.

106. RADIOFREQUANCY ABLATION
• Radioactive isotope ablation therapy for
Papillary carcinoma of thyroid in a post
operative setting with regards to: i) Indications
ii) Isotopes used iii) Pre procedure precautions
iv) Post procedure instructions v) Follow up
and surveillance .

107. TBI HBI
• Hemibody irradiation
a) Technique of Total Body Irradiation
b) Indications of Total Body Irradiation
c) Acute effects of Total Body Irradiation
Techniques of total body irradiation. b) What are the organs to be shielded in total
body irradiation and how?

108. • a) List the indications of Hemibody Irradiation
(HBI). b) What are the types of HBI? c)
Technique and doses involved in HBI. d) Pre &
post procedural precautions to be taken for
delivery of HBI.
Indications, technique with Physics aspect and
side effects of total body irradiation.

109. CRANIAL IRRADIATION
• Rationale, indications, technique and results
of cranial irradiation in Acute Lymphoblastic
Leukemia.

110. SNB SENTINEL NODE BIOPSY

111. RT IN BENIGN DISEASE
• a) What are the non-malignant intracranial
lesions treated with radiotherapy?
b) Radiotherapy technique and dose of thyroid
ophthalmopathy.
Tabulate a list of indications and radiation time-dosefractionation
schedules when ionizing radiation is used in nonmalignant
situations.

112. • ) Enumerate non malignant conditions where
radiation therapy is used. b) Prescribe the
dose required to treat a meningioma and a
keloid.

113. IORT
• Rationale and technique of intraoperative
radiation therapy.
Intra-operative radiotherapy.

114. CSI
a) Prophylactic cranial irradiation in leukemia
b) Prophylactic cranial irradiation in small cell lung
cancer
Indications of:
i. Whole brain irradiation
ii. Craniospinal irradiation

115. PRE OP RT

116. VIRUS ONCOGENE VACCINE
• a) What are the tumours associated with
chronic infection of HPV? Explain the
pathogenesis of developing malignancy? b)
What are the strategies used for prevention of
malignancy in patients thus infected?

117. • a) What are the viral infections associated
with CNS lymphoma?
a) Human Papilloma Virus (HPV) and head & neck carcinoma with recent evidence.

118. • Enumerate the viruses causing cancer. b) Role of
Human Papilloma Virus in human carcinogenesis
and the vaccine to prevent this infection.
Molecular pathways involved in the pathogenesis
of human papilloma virus infection.
• b) Role of human papilloma virus in:
• i. Head & Neck cancer
• ii. Carcinoma cervix
• iii. Carcinoma anal canal

119. CHEMO RADIATION
a) What are the goals for the combination of chemotherapy
with radiotherapy?
b) What are the two different ways the two modalities can
interact?
c) Describe the radiobiologic concepts that are exploited in
combination of radiotherapy and chemotherapy.
d) What are the mechanisms of interaction between drug and
radiation - give examples?

120. • Transarterial chemo-embolisation: Selection
criteria, indications, contraindications & side
effects.
Merits and demerits of concurrent chemo-
radiation. b) Enumerate the sites where
concurrent CT-RT is the standard of care.

121. CHEMO BIOTHERAPY
• a) What are TKIs?
• b) Mention with diagram their mechanism of
action.
• c) Enumerate the TKIs used in clinical practice.
• d) What are the various conditions meriting
the use of TKI?
• e) What is the present day clinical evidence for
their use?

122. • Anti-angiogenic agents have been used successfully and
unsuccessfully in the management of cancers. a) Name
the target/pathway used for anti angiogenic agents.
Name the generic drugs. b) Dose limiting toxicities of
such agents. c) One clinical site where it has succeeded
– describe how integrated with treatment. d) One
clinical site where it was not succeeded – describe how
integrated with overall treatment.
Integration of molecular targeted approaches with
radiotherapy:
a) Give examples
b) Rationale
c) Clinical trials

123. • Problems of giving chemotherapy to elderly
patients.
Management of: i. Extravasation of
chemotherapeutic agent. ii. Radiation induced
haemorrhagic cystitis. iii. Hypersensitivity
reaction following administration of
chemotherapeutic agent.
a) Classify chemotherapeutic agents. b) Enumerate the toxicities of alkylating agents.

124. • Indications, rationale and schedule of choice
for metronomic chemotherapy in head and
neck cancer along with expected response
rates.
Select any of the five cancer
chemotherapeutic agents and describe how
will you manage the side effects when these
drugs are used as chemosensitizing agents.

125. • a) Name four situations which require
modification of doses of anti-neoplastic
chemotherapy. b) Indications, mechanism of
action & side affects of: i) Carboplatin ii)
Sorafenib.

126. • What is EGFR? b) Name the malignancies that
are associated with the overexpression of
EGFR. c) Explain the role of EGFR targeting in
three common cancers.
a) What are tyrosine Kinase inhibitors?
b) Their clinical application in any one cancer.

127. • a) Classify targeted therapy. b) Axitinib.
Enumerate hormone responsive tumours and
describe hormone therapy most commonly
used in one of these tumours.
What is the mechanism of action of taxanes?
b) Enumerate the sites where they have an
established role, as per literature. c) What are
their toxic side effects?

128. • Indications, dose schedules and results of
targeted therapy in renal cell carcinoma.
Rationale, advantages and disadvantages of
neo-adjuvant chemotherapy. b) Current status
of neo-adjuvant chemotherapy in head and
neck carcinoma.

129. CLINICAL TRIAL
a) What are the various phases of a clinical trial?
b) The need to define a patient population, randomization &
stratification.
c) The need to define ‘trial stopping rules’, intention to treat
analysis & per protocol analysis.
What is meant by:
a) True positive and False positive
b) Positive and Negative predictive value
c) Confidence interval
d) Odds ratio and Hazard ratio

130. • a) Sensitivity
• b) Specificity
• c) Odds ratio
a) Discuss the various phases of a clinical trial.
b) What sample size is important in a clinical trial?
c) What are univariate and multivariate analysis?

131. • . a) What is meta-analysis? b) List the
components of a Forest plot. c) Take any two
examples of meta-analysis and describe how
the results of a meta-analysis serve to change
clinical practice.

132. • a) With regards to a diagnostic test, define
sensitivity, specificity, positive predictive value
and negative predictive value.
Various levels of evidence, with one example
from medical literature for each level of
evidence.

133. • a) With reference to medical Statistics,
define:- i) Null hypothesis ii) Power of a study.
b) Is evidence provided by Randomised
Controlled Trial (RCT) better than Case
Reports? Explain. c) What is phase III clinical
trial? Give example of a Phase III trial in
radiotherapy of breast cancer.

134. • a) How will you meet the statistical
requirements of number of patients in your
research project? b) How does confidence
interval change ‘the sample size’?
Write short notes on: 1. a) What are Phase I,
II, III trials? b) What is the power of study? c)
How would you determine the sample size?

135. • Statistical tests used in the analysis of
effectiveness of a screening test.
How will you design a Phase III Clinical Trial in
Oncology?
• b) Define interim analysis, definitive analysis and
secondary
• analysis.
• c) Current guidelines for reporting Randomized
Clinical Trials in
• Radiation Oncology.

136. • Define five levels of evidence with one
example for each level that is being used in
clinical practice.
Necessity of evidence based medicine. b) How
you will assure creation of evidence? c) What
are the follow up methodologies as
recommended by IARC (UICC)? a) Various
phases of clinical trials. b) Role of phase III
clinical trial in oncology.

137. PALLIATION SUPPORTIVE
• a) Principles of palliative care.
• b) Management of brain metastases.
• c) What is the role of corticosteroids and
anticonvulsants in brain metastases?
a) Enumerate the various emergencies seen in oncology
practice.
b) With regard to the superior vena cava syndrome describe:
1. Causes
2. Signs and symptoms
3. Management

138. • ) Principles of Palliative Care.
b) Euthanasia: Legal aspects in India.
How would you assess cancer pain?
b) Steps of management of pain in advanced
malignancy of head and neck region.

139. • What are the goals of palliation in a cancer
patient? b) What aspects will you take care of
in a terminally ill cancer patient admitted in
your ward for the past one week?
General principles of cancer pain
management.
• b) Management & interventions for:
• i. Bone pain syndrome
• ii. Nerve pain syndrome

140. PHYSICS

141. a) The distinction between beam modifying and beam direction.
b) Need for wedge filters in radiotherapy.
c) Enumerate methods by which a dose distribution identical to
that of a physical wedge filter can be created without using a
wedge filter.
d) What is meant by wedge angle and hinge angle and their
general guiding relationship?

142. • a) Percentage depth dose.
• b) Factors influencing Percentage depth dose.
• c) Mechanism that explains the location of
Dmax and it variation with various photon
energies.
• d) Field equivalence of rectangular fields for
central axis depth dose distribution.

143. • With regard to immobilization & positioning
devices:
• a) Describe those in common use for various sites
of the body.
• b) What is the basic purpose of their use?
• c) How do you calculate the precision of
relocation?
• d) How do you correct errors in relocation on the
treatment table?

144. • a) What is meant by APBI?
• b) What is the rationale for APBI?
• c) What are the various ways, including dose
schedules, in which APBI is done?
• d) Discuss the clinical evidence in favour of or
against APBI.

145. • a) ICRU target volumes in external beam
radiotherapy.
a) Name the three interactions of X-rays with matter.
b) What is Compton effect?
c) Why Compton effect is preferred in radiotherapy and not in
Radiodiagnosis?
d) What are the various types of DVH? What are the
advantages of DVH?

146. Draw the isodose curves for (representative of a typical
beam):
a) Photon beam
b) Electron beam
c) Proton beam
d) 250 KV beam
e) Carbon ion

147. • Physical properties of a Cobalt 60 source and
the principles of radiation protection in the
Cobalt unit and HDR Brachytherapy bunker.
• b) Biodosimetry in a post exposure situation.
Mention half life & energy of following isotopes:
a) Cobalt 60
b) Iridium 192
c) Caesium 137
d) Radium 226
e) Tantalum 182

148. • a) What is the role of sealed and unsealed
radionuclide sources in cancer management?
• b) Discuss different altered fractionation schemes
and their rationale.
• c) What are the different types of immobilization
devices used in head and neck radiotherapy?
Define & discuss factors affecting:
a) Photo electric effect
b) Compton effect
c) Pair production

149. a) What is asymmetric collimation?
b) Use of wedges
c) Use of tissue compensators
Write the utility of each, giving examples:
a) Alpha particles
b) Beta particles
c) Gamma rays
d) X-rays
e) Carbon Ion Therapy

150. • a) Tabulate differences between Compton
effect, pair production and photoelectric
effect. b) What factors affect the attenuation
of radiation as it traverses matter?
Role of following in diagnosis and RT planning, giving
suitable examples:
a) CT Scan
b) MRI
c) PET-CT
d) Conventional Imaging

151. • Describe the way of evaluating radiotherapy
treatment plans with dose volume histogram
and biological indices.
a) Define percentage depth dose. b) What are
the factors influencing percentage depth
dose?

152. • a) Name the essential tools of plan evaluation.
b) Explain why one of the methods alone is
not sufficient, with suitable example. c) ICRU-
83 a) Name the three interactions of X-rays
with matter. b) What is Compton Effect? c)
Why Compton Effect is preferred in
radiotherapy and not in radiodiagnosis?

153. • a) Draw a teletherapy machine room for
Cobalt/Linear Accelerator. b) List the various
methods of radiation protection in
Cobalt/Linear Accelerator room. c) What are
the advantages of a maze wall?

154. • Enumerate the various acceptance tests done
before commissioning a linear accelerator for
patient treatment. b) Limits and tests for
determining beam flatness and beam
symmetry.

155. • Define GTV, CTV, ITV & PTV.
b) Enumerate the salient features of ICRU 50
and 62.
What is dose volume histogram (DVH)? b)
How is it computed? c) What are its pitfalls? d)
Give one example of how you would
interpret/utilize DVH.

156. • Various devices used for radiation monitoring.
• b) Rationale, structure, advantages and
disadvantages of any one personnel
monitoring device.

157. UNKNOWN PRIMARY
• An 80-year-old lady presented with a left
supraclavicular lymph node which on aspiration
cytology was an adenocarcinoma. Describe:
• a) Possible sites of origin of this secondary site of
spread.
• b) List history taking and physical examination
points of relevance- explaining what might be the
investigative lead of each query / finding.
• c) Investigations ordered and their rationale.

160. MODERN RT

161. • What are the advantages & disadvantages of:
• a) Conventional Radiotherapy
• b) 3-D CRT
• c) IMRT
• d) IGRT
• e) SRT

162. • a) What is the purpose of IGRT? In what way it
differs from 2-D RT, 3-D CRT and IMRT?
• b) Describe different methods of imaging
techniques used for IGRT.
• c) KV versus MV imaging.
a) Forward planning in radiotherapy
b) Inverse planning in radiotherapy

163. • a) Electron Arc Therapy
• b) Cone beam systems and its relevance
• c) Electron portal imaging devices
• d) QA procedures for IMRT treatments
Respiratory dampened radiotherapy
b) Respiratory gated radiotherapy
c) 4 DCT

164. • a) Define and explain the principle of
Stereotactic Radiation. b) Mention the
differences between Stereotactic Radiosurgery
(SRS) and Stereotactic Radiotherapy (SRT) c)
What are the tolerance doses of optic chiasm
and brainstem for SRS and SRT brain stem? d)
Radiobiological concept of SRS for
Arteriovenous Malformation (AVM).

165. • a) What is Involved Field Radiation Therapy
(IFRT), Involved Nodal Radiation Therapy
(INRT) and Involved Site Radiation Therapy
(ISRT)? b) ISRT technique for bulky mediastinal
adenopathy and its advantages.

166. • a) What are the objectives of real-time
tumour tracking? b) Compare and contrast the
two real time imaging systems currently
available in clinical use.
Define 3D conformal Radiotherapy. What are
the advantages of 3D conformal Radiotherapy
over 2 dimensional planning?
• b) In 3D CRT, enumerate the steps of Plan
Implementation

167. • Compare Gamma Knife with X-Knife. What is
Stereotactic Body Radiotherapy (SBRT)?
b) Enumerate the sites in which SBRT has a
role and why.
What is image guided Radiotherapy? b) What
are the possible ways of doing image guidance
currently?

168. • Define IGRT (Image Guided Radiotherapy) and
specify the requirements for an ideal image
guidance system in radiotherapy.
• b) Clinical applications of IGRT in current
practice

169. • It is proposed to install a linear accelerator in a
Radiotherapy Department equipped only with
cobalt 60 units.
• a) What should be the optimum energy of this
unit? Give your reasons.
• b) What are the quality assurance checks that
should be carried out before the accelerator is
introduced for clinical use?
• c) What would be the advantages/disadvantages
of very high energy beam (50 MV/100 MV) in
Teletherapy?

170. Mri Pet CT
• a) Role of MRI imaging in radiotherapy
treatment planning b) Role of PET CT in
radiotherapy treatment planning.
Enumerate radioisotopes used for PET scan
alongwith their half lives. Provide evidence of
usefulness of PET scan in oncological
management of cancers.

171. • Principle and application of PET scan in Oncology.
b) Its current status based on evidence in
literature for radiation treatment planning of lung
cancer.
Physical principles for the basis of Positron
Emission
• Tomography and describe the various isotopes
used in PET scans in current day practice.
• b) Current applications of PET-CT scan in
Radiotherapy treatment planning

172. QA
• a) What is the goal of Quality Assurance (QA)?
b) Mention the acceptance tests involved with
Multi-leafcollimator (MLC). c) List the monthly
QA checks done for a Telecobalt machine.

173. • Enumerate quality control tests done on a
Linear Accelerator. b) How would you
determine field symmetry and beam flatness
on a linear accelerator?
What do you understand by Quality Assurance
in Radiotherapy? b) Explain briefly the areas
you will undertake QART.

174. • What Quality Assurance Checks are used to
confirm the validity and accuracy of a 3D CRT
Plan

175. RADIOBIOLOGY

176. • a) What are the quantities and units used for radiation
protection purposes?
• b) Compare stochastic effects and non-stochastic
effects.
• c) Radiation dose limits for radiation workers, pregnant
women and lay public.
a) Describe the phases of cell cycle.
b) What is the effect of X-rays on synchronously dividing cells
with regard to the cell cycle?
c) What is the effect of oxygen at various phases of the cell
cycle?
d) Molecular checkpoint genes and cell cycle.

177. • a) What are Radio sensitizers?
• b) Describe the types of radio-sensitizers that
have found practical use in clinical radiotherapy.
• c) Results of Meta-analysis of trials addressing
problem of hypoxia.
• d) ARCON trial
a) Distinguish between radio sensitivity, radio responsiveness
and radio curability.
b) What factors can modulate radio sensitivity?
c) How is radiation induced damage measured in the cellular
and organ systems?

178. • Write the rationale behind, giving examples:
• a) Neoadjuvant chemotherapy followed by
radiotherapy
• b) Radiotherapy followed by adjuvant
chemotherapy
• c) Concurrent chemoradiotherapy
a) What is cell survival curve?
b) Discuss the various components of the curve.
c) How would its shape differ for neutrons versus X-rays?

179. • a) Define radiocurability
• b) Define radiosensitivity
• c) Factors accounting for different
radiosensitivities of tumours.
• d) Factors to overcome radioresistance

180. • a) Deterministic effects of radiation.
• b) Stochastic effects of radiation.
a) Explain a cell survival curve with a suitable diagram. b) Explain how the curves are
different for low and high LET radiations
a) What is oxygen enhancement ratio? b) Explain the importance of
oxygenation during fractionated radiation using photons and
neutrons

181. • a) What is maximum permissible dose?
b) What are the recommendations for this?
Explain ALARA principle.
Process of angiogenesis. b) What are the
agents that are being used as anti-angiogenic
therapyenumerate along with the sites they
are used in?

182. • a) What are the various fractionation
schedules in radiotherapy? b) Explain the
radiobiological basis for each of them.
.Therapeutic ratio and its clinical significance.

183. • What is the radiobiological basis of
hypofractionated RT (HFRT)? b) Enumerate
the sites in which HFRT is being used along
with its evidence.
Linear quadratic model in the practice of
radiotherapy.
• b) Clinical implications of the alpha beta ratio
in modern radiotherapy.

184. • What is therapeutic ratio? b) What is its
clinical significance in radiation oncology?
a) What are the deterministic and stochastic
effects in radiotherapy? b) Radiation induced
carcinogenesis.
Acute radiation syndrome encountered in an
accidental exposure of the whole body to
radiations in terms of dose range, clinical
effects and outcome.

185. • What are functional subunits? b) What is
serial and parallel architecture? c) How does it
impact upon the normal tissues responses
towards radiation?
Principle of ALARA. b) Enumerate the dose
limits for exposure to occupational workers.

186. • 0. What do you understand from cell
heterogeniety in a tumour cell population?
How does it manifest in your clinical practice.
What steps are required for its management?

187. • Depict the cell cycle in a diagram and
enumerate the mechanisms of biological
effects of ionizing radiation at the cellular level

188. • List the types of radiation damage to
mammalian cells and give the features
associated with each of them.
• b) Mechanism of repair of the damages when
radiation dose is given in fractions.
• c) What clinical applications could be derived
from this process?

190. MISCLLANEOUS
Explain the physiologic / mechanistic basis of:
a) Visual field defects in a patient with a right occipital glioma.
b) Mechanisms of breathlessness in a patient with
bronchogenic carcinoma.
c) Aspiration in a patient with oropharyngeal cancer, pre and
post radiotherapy.

191. • What is the rationale of the choice of
prescription point /normalization method in:
• a) Conventional 2 D radiotherapy planning
• b) Intensity modulated radiotherapy
• c) Radiosurgery

192. • a) What are the radionuclides and their
properties that are used for diagnosis and
imaging?
• b) What is the role of radionuclides that are
used for the diagnosis and management of
multiple bone metastases?
With regard to re-irradiation:
a) List the considerations when advising re-irradiation for a
recurrent tumour.

193. • a) What is the principle of flow cytometry?
b) How is it useful in diagnosis of malignancy?
Give examples.
Uncertainties that may be encountered in
planning of a patient undergoing a course of
radiation
Discuss the effects of radiation on :
a) CNS
b) Kidneys
c) Heart

194. • . a) When is an intrafractional motion
management strategy utilized when treating
with radiation therapy? b) What sites, in the
human body, may require such strategies?
c) What are the broad categories of motion
management from a technical perspective?
d) Explain in a schematic diagram, any one site
and a related commercially available motion
management strategy of your choice

195. • Biological basis of metastasis and various
modes of metastasis.
a) Why are tumor registries useful? b) What is the main difference between the two major
types in India? c) Using one cancer as an example, can you list the variability of cancer
incidence in India?

196. • a) Prognostic and Predictive markers. b) Use of
CEA and CA-125 as prognostic and predictive
markers.
A 32 year old lady presented with decreased urinary output, bilateral pedal oedema and
severe backache. She also gives history of bleeding per vaginum for 3 months. On evaluation,
she was found to have creatinine of 5.4mg/dl and Potassium of 7.0mEq/ml a) What other
blood investigations will you do for emergency management? b) How will you correct her
hyperkalemia? c) What is the possible diagnosis? d) Outline the treatment algorithm for such
a patient

197. • Enumerate investigation profiles along with
tumor markers for lung cancers & ovarian
cancer in view of modern therapeutic
approach.
.What is thermoluminiscence? What are its
clinical and lab applications?

198. • What is gated radiation therapy and what are
the malignancies where it has been found
useful?
Fundamentals of oncological management in
elderly patients (age > 60 years).
Management of anaemia in overall
oncological management.

199. • Enumerate tumor markers associated with
Genitourinary cancers and their role in
oncological practice.
What is the radiation tolerance of ovary and
testes? b) Fertility preservation in overall
oncologic management.

200. • What is gating in radiotherapy? b) Where is it
used and how?
What is Adaptive Radiotherapy? b) In which
sites has it been used? c) What are its
problems and limitations?
Enumerate the emergencies in oncology. b)
Indications, dose schedules technique and
results of radiation therapy for spinal cord
compression treatment in malignancy.

201. • Enumerate the ways in which you can palliate
bone metastasis. b) Indications, technique and
results of Strontium-89 therapy in bone
metastasis.
Circumstances in Indian scenario that compel
the curable cancers to become incurable.

202. • ) What are the components of tumour board
approach in management of malignant
diseases? b) How is consensus treatment
policy achieved? c) What is the basis of
recommendatio n of a consensus treatment? )
Fundamentals of therapeutic approach in
geriatric patients with malignancy

203. • National Cancer Control program with respect
to its aims and implementation.
What do you understand by a “Tumor
Registry” or Cancer Registry? b) How will you
set up such a department in your institution?
c) What are its advantages?

204. • Identification (diagnosis), pathogenesis and
management of tumour lysis syndrome.

205. GENETICS
• a) Explain what are tumour suppressor genes
and protooncogenes with examples.
• b) Mechanism of oncogene activation.
• c) Inactivation of tumour suppressor genes.
• d) Multistep nature of carcinogenesis with
example.

206. • a) Proto-oncogenes.
• b) Tumour suppressor genes.
What are oncogenes? Give examples along with their importance
a) Polymerase Chain Reaction (PCR): Principles & procedure. b) Mention
the types of PCR. c) List its advantages and limitations.

207. • Molecular & genetic pathology involved in
tumorigenesis of any one of the tumours in
human body

208. ANATOMY
• Draw a schematic diagram of the lymphatic
drainage of the:
• a) Breast
• b) Middle third of the esophagus
• c) Left testis.

209. a) Describe using a schematic diagram the
various levels of lymph nodes of neck.
Describe lymphatic drainage of :
a) Breast
b) Cervix
c) Anterior two thirds tongue

210. • Blood supply and lymphatic drainage of testis.
Anatomy and lymphatic drainage of larynx.
a) Embryology, surface anatomy and
radiographic anatomy of sella tursica.
Anatomy of uterine cervix and its adjacent
structures as it relates to therapeutic
approach in late stage cervical cancer.

211. • Define the levels of lymph nodes in the neck.
b) What are the guidelines for delineation of
LN bearing regions (i.e high risk and low risk
CTV) in the neck? Anatomy of brain in relation
to Radio/Chemotherapeutic management of
brain tumours.

212. • ) Enumerate various nodal stations in
mediastinum with help of diagram(s).
Anatomy & lymph drainage of the testes
Anatomy and lymph drainage of the uterine
cervix.

213. SCREENING
a) Screening for cancer and its goal using one tumor site as an
example.
Enumerate the general principles of screening. c) Various methods (modality and schedule) of
cervical cancer screening.

214. • What is cancer screening? b) What are the
goals of cancer screening? c) What sites are
suitable for cancer screening and why?
Define surveillance. b) Enumerate the sites
and stage where surveillance is an option
along with a brief description of how it is
recommended to be carried out in cancer
patients

215. • Enumerate the current guidelines for Breast
Cancer Screening for women at normal risk of
developing cancers.
Various imaging modalities used in the
screening for cancer breast.

216. BRAIN METS
• a) Treatment options of single metastasis in
the brain with controlled extra-cranial disease.
b) Evidence for focal radiotherapy Vs whole
brain radiotherapy. c) What is the use of
Recursive Partitioning Analysis (RPA)
classification?

217. staging
• Write the AJCC staging of oral cavity cancer
What is TNM staging system? b) Why is it
used? c) Give TNM staging of lung cancers.
a) Latest FIGO staging system for cancer of endometrium

218. WHO classification
• Write WHO classification of lung tumours
Classify bone tumours with special reference
to its immunohistochemistry
Enumerate the pathologic subtypes as per
WHO classification of lung cancers, briefly
describing their salient points.

219. • Classify childhood tumours..