HEAPHY 1 & 2

CASE RACE 2 – RT

Tony FALLON

Sat 31st Aug 2013

Session 3 / CR2-2

13:41 – 13:45

CANTERBURY / WESTLAND

ABSTRACTThis case race presents the case of a lymphoma patient who was scanned/planned and treated for an abdominal lymphoma and during the treatment, it disappeared and was not visible on imaging.... this set in motion the process of turning computer screens around, changing windowing levels and calling multiple staff around to try and see the volume and then a major discovery was made on a cone beam CT.

Anthony Fallon

Radiation Therapist

Canterbury Regional Cancer and Haematology Service

Chasing the Tumour Around Christchurch

Patient

• Female, 46 YO

• Original Diag. May 2003 - Stage IV Diffuse large B cell lymphoma

• January 2013 – 1/52 Hx of adbo swelling and bowel changes >>> Lt Sided Mesenteric Abdominal Mass

Quick Recap

In anatomy, the mesentery is the double layer of peritoneum that suspends the jejunum and ileum from the posterior wall of the abdomen.

Wikipedia

January 2013

Initial Treatment

• 3 Cycles up to April

• Rituximab on day 1• Cyclophosphamide days 2‐4 Q12H• Vincristine days 5 and 12 (2 doses)• Doxorubicin day 5• Dexamethasone days 2‐5 and 12‐15

Diagnostic Scan April 13

CT Planning Scan May 13

RT Plan

RT Plan

• Gross Tumour Volume = Visible mass

• Planning Tumour Volume = GTV + 1cm Margin Isotropically.

• Daily CBCT to localise Mass and Daily RO Review

CBCT Image Day 1

RT Treatment

• 30Gy/10 # over 2 weeks.

• Daily Ondensatron – Small amount of Abdominal Gurgling and Cramps.

• Initially increased in Size but then Good response

Last Day