A 6 YEAR OLD BOY PRESENTS WITH HEADACHE AND RECENT RIGHT LOWER LIMB WEAKNESS. AN MRI DEMONSTRATES A 4CM LESION IN HIS LEFT CEREBRAL HEMISPHERE

A 6 YEAR OLD BOY PRESENTS WITH HEADACHE AND RECENT RIGHT LOWER LIMB WEAKNESS. AN MRI DEMONSTRATES A 4CM LESION IN HIS LEFT CEREBRAL HEMISPHERE

A 6 year old boy presents with headache and recent right lower limb weakness. An MRI demonstrates a 4cm lesion in
his left cerebral hemisphere. A biopsy shows a WHO grade 2 glioma. His case is discussed in a paediatric meeting and
the decision is made to recommend definitive radiation therapy.
a) What are the main points you would discuss with this child’s parents about the rationale for radiation therapy,
side effects and potential late complications.
(4 marks)
b) Discuss how you would follow this boy after treatment, assuming you are managing this aspect of his care.
(3 marks)
c) In general, for primary CNS tumours in children, what factors would you consider when making a decision
about treatment with radiation therapy? Justify your answer.
(3 marks)
Question 2
PET scanning is now commonly used in cancer management.
a) Describe how PET scans can be employed in oncological practice. Illustrate your answer with three examples
from different tumour sites.
(4 marks)
b) What are the advantages and disadvantages of using PET scans in radiation therapy planning?
(4 marks)
c) Name a commonly employed radiotracer and describe its biological characteristics.
(2 marks)
Question 3
A 60 year old man with a 3 month history of back pain now presents with leg weakness and urinary retention. Plain
films demonstrate a lytic lesion at T10.
a) Describe how you would evaluate this patient.
(3 marks)
b) What factors would you consider in deciding on the management of this man?
Justify your answer.
(4 marks)
The patient is confirmed to have malignant spinal cord compression at T10 and is treated with palliative radiation
therapy alone.
c) Describe the general supportive measures you would organise for this man during and after his treatment.
(3 marks)
CLINICAL ONCOLOGY
Phase 2 Exam Written Papers 2011 Page 6 of 15
Question 4
In relation to waiting times prior to commencing a course of radiation treatment:
a) Describe the potential problems of delayed commencement of radiation therapy:
i) with respect to clinical outcomes, giving at least 4 specific examples.
(3 marks)
ii) with respect to other adverse effects for the treatment centre
(2 marks)
b) If your centre had unacceptable waiting times for radiation treatment, what measures could be used to
manage this?
(5 marks)
Question 5
You have been asked to chair a committee charged with the development of an Early Breast Cancer Treatment
Guidelines document.
a) Describe the process you would employ to develop such guidelines.
(5 marks)
b) What is meant by ‘levels of evidence’?
(1 mark)
c) Define the system of ‘levels of evidence’ that you would use within your guidelines document.
(4 marks)
Question 6
Part 1 – With regard to tumour lysis syndrome:
a) What are the patho-physiological and clinical features of tumour lysis syndrome?
(3 marks)
b) What measures can be used to reduce the risk of tumour lysis syndrome?
(2 marks)
Part 2 – With regard to statistical methods:
c) What is a meta-analysis and why are meta-analyses performed?
(2 marks)
d) What are the advantages and disadvantages of a meta-analysis over a single randomised controlled trial?
(3 marks)

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