meet me in treatment planning: head & neck · head & neck may 29, 2018. we have no...
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B E T H M . B E A D L E , M D / P H D
A S S O C I AT E P R O F E S S O R O F R A D I AT I O N O N C O L O G Y
N ATA L I YA K O VA L C H U K , P H D
C L I N I C A L A S S I S TA N T P R O F E S S O R O F R A D I AT I O N P H Y S I C S
S TA N F O R D U N I V E R S I T Y
Meet Me in Treatment Planning:Head & Neck
May 29, 2018
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W E H AV E N O D I S C L O S U R E S
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Case 1: HNARRO 2
• 73 year old male presented with a painless left neck mass.
• No dysphagia, odynophagia, weight loss, bleeding
• PMH: BPH
• No prior radiation, no pacemaker, no collagen
vascular disease
• PSH: Tonsillectomy as a child
• SH: Never smoker, retired executive.
• PE:
• Left palpable level II lymph node
• Oral examination: Firmness in the low left base of
tongue
• Endoscopy:
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Case 1: HNARRO 2
• FNA Left Neck: Squamous cell carcinoma – p16/HPV+
• MRI:
• PET:
• AJCC 8: T1 N1 M0 (Stage I)
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Case 1: HNARRO 2
• Contouring targets & normal tissues
• Dose allocations
• Use of templates
• Instructions to treatment planning team
• Be practical
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Case 1: HNARRO 2
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Case 1: HNARRO 2 Plan Review
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Case 2: HNARRO 3
• 67 year old female presented with painful right retromolar
trigone mass.
• No teeth loose, no bleeding, no weight loss
• PMH: Chronic kidney disease, hypothyroidism
• No prior radiation, no pacemaker, no collagen
vascular disease
• PSH: Cholecystectomy
• SH: 36 pack-year smoker; quit 20 years ago.
• PE:
• No palpable adenopathy
• Oral examination: Heaped lesion in the right RMT
with central ulceration
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Case 2: HNARRO 3
• Right RMT biopsy: Squamous cell carcinoma
• MRI:
• PET:
• AJCC 8: clinical T2 N0 M0 (Stage II)
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Case 2: HNARRO 3
• Surgical resection of the primary and right neck dissection:
• 2.8 cm moderately differentiated squamous carcinoma
• 8 mm depth of invasion
• Final margins negative
• LVSI present
• No PNI
• 32 lymph nodes removed
• 0 positive
• AJCC 8: pathologic T2 N0 M0 (Stage II)
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Case 2: HNARRO 3 Plan Review
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Case 3: HNARRO 1
• 24 year old female presented with left neck masses
• No dysphagia, odynophagia, pain, weight loss
• PMH: None
• No prior radiation, no pacemaker, no collagen
vascular disease
• PSH: None
• SH: No smoking history. Nursing student.
• PE:
• Confluent left level II-IV adenopathy
• No oral lesions
• Endoscopy: Mass arising from the left nasopharyngeal
wall and involving left torus and Eustachian tube. Lesion
extends to the roof of the nasopharynx.
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Case 3: HNARRO 1
• FNA Left Neck: Nasopharyngeal carcinoma, EBV-positive.
• MRI:
• PET:
• AJCC 8: clinical T1 N1 M0 (Stage II)
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Case 3: HNARRO 1 Plan Review
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Case 4: HNARRO 4
• 78 year old female presented with tongue pain
• Dysphagia, odynophagia, tongue mass.
• PMH: Hypertension, osteoporosis
• No prior radiation, no pacemaker, no collagen
vascular disease
• PSH: None
• SH: No smoking history.
• PE:
• Ulcerated right oral tongue mass
• No palpable adenopathy
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Case 4: HNARRO 4
• Biopsy: Squamous cell carcinoma
• MRI:
• PET:
• AJCC 8: clinical T3 N2b vs. N2c M0 (Stage IVa)
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Case 4: HNARRO 4
• Surgical resection of the primary and bilateral neck
dissection:
• 4.3 cm moderately differentiated squamous carcinoma
• 1.7 cm tumor thickness
• Final margins negative
• Perineural invasion present
• No LVSI
• 105 lymph nodes removed
• 0 positive
• AJCC 8: pathologic T3 N0 M0 (Stage III)
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Case 4: HNARRO 4 Plan Review
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Questions?
• Head and neck physicists
• Head and neck dosimetrists
• Radiation therapy team
• ASTRO
• ARRO
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Acknowledgements