Table 1. Survey Questions and Answer Choices.

Question #	Question Stem	Question Answer Choices
1	A 60 year old woman without significant past medical history presents with a 7 cm anterior mediastinal mass. She has intermittent chest pressure, but no symptoms of myasthenia. CT scan demonstrates a tumor in contact with the pericardium, but a fat plane is present. There is no evidence of distant metastatic disease, and there is no involvement of the lung, liver, bone, or pleura. What is your initial evaluation to obtain a pathologic diagnosis?	Endobronchial ultrasound and fine needle aspiration (EBUS-FNA) Core needle biopsy Mediastinoscopy Chamberlain Procedure (anterior mediastinotomy) Total thymectomy
2	A 65 year old physically fit patient undergoes a complete thymectomy for a 3 centimeter thymic tumor. Pathology review identifies a thymic carcinoma (Masaoka stage II) with all margins negative. What do you recommend for postoperative management?	Observation Radiation therapy only Chemotherapy followed by radiation therapy (sequential) Chemotherapy and radiation (concurrent) Chemotherapy only
3	A 65 year old physically fit patient undergoes a complete thymectomy for a 3 centimeter thymic tumor. Pathology review identifies a thymic carcinoma with involvement of the pericardium (Masaoka stage III) with all margins negative. What do you recommend for postoperative management?	Observation Radiation therapy only Chemotherapy followed by radiation therapy (sequential) Chemotherapy and radiation (concurrent) Chemotherapy only
4	A physically fit 55 year old patient presents with a Masaoka stage IVA thymic carcinoma with an anterior mediastinal mass and multiple pleural nodules (>5). What is your recommended surgical management?	Surgery alone Neoadjuvant chemo followed by surgery and postop RT Neoadjuvant concurrent chemotherapy and radiation therapy followed by surgery Surgery with neoadjuvant or adjuvant chemotherapy Definitive concurrent chemotherapy and radiation therapy Chemotherapy alone
5	A physically fit 55 year old patient presents with a Masaoka stage IVA thymic carcinoma with an anterior mediastinal mass and multiple pleural nodules (>5). What is your recommended surgical management?	Biopsy of pleural nodules only Complete thymectomy Complete thymectomy and resection of gross pleural nodules Complete thymectomy and partial pleurectomy/decortication Complete thymectomy and total pleurectomy/decortication Complete thymectomy and extrapleural pneumonectomy
6	A 43 year old woman presents with Masaoka Stage IVB thymic carcinoma with an anterior mediastinal mass and multiple metastatic lung nodules (biopsy confirmed to represent metastatic disease). What is your preferred initial chemotherapy?	Cisplatin/etoposide Doxorubicin, cisplatin, vincristine, and cyclophosphamide Cisplatin, doxorubicin, cyclophosphamide Platinum/taxane combination (cisplatin/docetaxel, carboplatin/paclitaxel)
7	A 50 year old patient presents with a 5 × 6 centimeter anterior mediastinal mass with invasion into the mediastinal fat, but not the lungs, pericardium, heart or great vessels. On exam, two cervical (jugular and supraclavicular) lymph nodes are identified and found to be biopsy proven thymic carcinoma. What is your recommended treatment course?	Chemotherapy only Thymectomy and lymph node dissection alone Neoadjuvant chemotherapy followed by thymectomy and lymph node dissection Neoadjuvant concurrent chemotherapy and radiation therapy followed by thymectomy and lymph node dissection Thymectomy and lymph node dissection with neoadjuvant or adjuvant chemotherapy Neoadjuvant chemotherapy, thymectomy and lymph node dissection followed by postoperative RT Definitive concurrent chemotherapy and radiation therapy
8	A 65 year old patient presents with a 13 × 15 centimeter thymic carcinoma in the anterior mediastinum with invasion into the great vessels, pericardium and lungs bilaterally. What is your next recommended treatment step?	Chemotherapy only Neoadjuvant chemotherapy followed by surgery Neoadjuvant concurrent chemotherapy and radiation therapy followed by surgery Definitive chemotherapy and radiation therapy (sequential or concurrent) Radiation therapy only
9	A 65 year old patient presents with recurrent thymic carcinoma in the anterior mediastinum measuring 8 × 6 centimeter in size and invading the right upper lobe of the lung. A staging workup does not reveal any distant metastatic disease, pleural or pulmonary nodules. He initially presented with stage II thymic carcinoma 2 years ago and underwent surgical resection without any chemotherapy or radiation therapy. What is your recommended treatment course?	Chemotherapy only Neoadjuvant chemotherapy followed by surgery Neoadjuvant concurrent chemotherapy and radiation therapy followed by surgery Surgery only Radiation therapy only Definitive chemotherapy and radiation therapy (sequential or concurrent)
10	A 50 year old patient is found to have unresectable thymic carcinoma due to invasion of the great vessels. What is your recommended treatment course?	Surgical debulking only Surgical debulking followed by definitive radiation therapy Surgical debulking followed by definitive chemoradiation therapy Definitive radiation therapy Definitive chemoradiation therapy Chemotherapy only
11	A 60 year old patient presents after an R1 resection of a stage III thymic carcinoma with involvement of the adjacent lung and pericardium for adjuvant radiation therapy. The mediastinal margin is microscopically involved with malignancy. Which radiation technique would you find acceptable?	2D 3D conformal radiation therapy Intensity-modulated radiation therapy Tomotherapy Proton therapy
12	A 60 year old patient presents after an R1 resection of a stage III thymic carcinoma with involvement of the adjacent lung and pericardium for adjuvant radiation therapy. The mediastinal margin is microscopically involved with malignancy. Which radiation dose would you find acceptable? 1. 45 Gy 2. 50 Gy 3. 54 Gy 4. 60 Gy 5. 70 Gy	1 1 and 2 2 and 3 3 and 4 4 and 5