CASE STUDY

RAYMOND HOVE
44-year-old
Lives with by
woman from
herself
Rotorua SOCIAL
HISTORY
Referred to our
cancer service
One daughter
following a
who lives with
mass found in
her mother
her
mediastinum.
SOCIAL HISTORY

• Long history of smoking

• Smoking cigarettes is the
main cause of lung cancer.
• 90% people who get lung
cancer are smokers or ex-
smokers.
• About 10% have never
smoked
PRESENTING
SYMPTOMS

• SOB on exertion (dyspnea)

• Upper airway compression
• ECOG performance status = 2
 CT-SCAN

INVESTIGATIONS

PET-CT

BIOPSY
TNM STAGING
SYSTEM
• Tx – no definite primary lung
tumor
• N3 – Ipsilateral mediastinal
nodal involvement
• M=0 no metastasis to distant
regions
 • Curative with the intent of eradicating
the disease.
TREATMENT • Chance of being cured <10%.
INTENT/RATIONALE
• Concurrent chemotherapy:
Cisplatin/etoposide
OTHER MEDICAL
HISTORY

• Left laryngocele
• Bilateral breast
fibroadenomas removed
• Right ovarian pain
• Total abdominal hysterectomy
• Thyroidectomy for grave
thyroiditis
MEDICATIONS

• Omeprazole
• Paracetamol and ibuprofen
• Laxsol
• Ondansetron
• M-Elson
• Metronidazole & doxycycline
• Ferro gradumet
• Ventolin and Symbicort inhalers
COMPUTED TOMOGRAPHY

CONTRAST : 4DCT: where CT

OMNIPAQUE → slices acquired at
improves nodal different phases of
definition respiration.
PATIENT SETUP

What are we trying to achieve?

1. Provide patient comfort
(comfortable patients are less
likely to shift position)
2. Are reproducible (to enhance
radiation accuracy)
3. Are custom fitted (enhancing
comfort and reproducibility)
PATIENT SETUP

Head First Supine

Vacbag secured in position by an indexed shuttle

board

LR (Indexed)
PLANNING

Prescription: 60Gy/30#, 2Gy/#, 1#/day 5#/week over

6 weeks to the ICRU reference point
 • The ICRU reports 50 and 62 provide specific
ICRU 50/62 information for guiding radiation treatment.
VOLUMES

• GTV
• CTV
ITV
• PTV
ICRU REFERENCE POINT

The ICRU recommends reporting the dose at a The point should be clinically relevant, easily
single point within the PTV. defined, and placed in a region of uniform dose
(away from steep dose gradients or inhomogeneities
if possible).
INHOMOGENEITIES

Table 1. Relative Electron Density  

Tissue Relative Electron Density Hounsfield Unit

Water/Soft tissue 1.0 0

Air 0.3 -700

Bone 1.3-1.8 +1000

 Online is when images are checked before pt
has their tmt

IMAGING
VERIFICATION Offline after pt has had their treatment.

Waikato Protocol: daily online review and

weekly offline review during weekly checks
ONLINE IMAGING

• Daily KV/KV every non CBCT

day: Primary match is a bone match.
• CBCT weekly every Wednesday:
Primary match is bone and
secondary match assesses
contours/soft tissue and OARs. Also
able to access disease progression
 • SKIN

CRITICAL • OESAPHAGUS
STRUCTURES • LUNGS
• SPINAL CORD