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Mostafa El-Haddad
MD., FRCR., HMD.
Tips and
Tricks ™
By
Category 1 Priority;• SCC of the head and neck region.• SCC cervix.• Non-small cell carcinoma of lung.
Guidelines for the Management of the Unscheduled Interruption or Prolongation of a Radical Course of Radiotherapy (2nd Edition. 2002).
MD Anderson series showed that completed combined treatment (Surgery + Radiotherapy) in 11 weeks is better than 11 to 13 weeks and more than 13 weeks is the worst.
Why Head And Neck Is Special
•Very Complicated anatomy.
•Many risk organ in a very narrow space.
•Needs high precision.
•Patients in very bad shape.
•RCR report for priority.
General
Positioning
Head Rest
Trick!
A comfortable head support is one that tightly fits to the posterior surface of the head and neck and help the patient to maintain the position without straining.
The neck is rested but not the head, this open room
for a movement
•Supine Position.
•Lateral position
•Open neck position.
Lateral or Open Neck
Extension is it Necessary?
Brain inclusion with more extension.
Neck to be included or not.
Neutral Chin Position
Neutral Position
Maxillary Sinus
Another Method
Gantry
Head supportsHyperextension can be achieved by elevating the chest without make a strain on the head.
When Extension is Not Necessary?
Oral Cavity
Pushing The lip forward in Tongue cancer But avoid tissue equivalent material
Tongue depressor may be different
Spot the difference?
Tongue BiteOr
Mouth Opener
Shielding Stents
Open Mouth or Closed when
and why?
Hypopharynx
With Tongue Bite
Without Tongue Bite
Energy Used
Ipsilateral neck failure as first event (13%) than patients treated by 60C0
and 4 MV (9%).This difference was not statistically
significant.
Beam Spoiler
Larynx
1- Identify the anatomy and orientation. 1- Identify the anatomy and orientation. 2-Which is an indirect (mirror) laryngoscopy view 2-Which is an indirect (mirror) laryngoscopy view and which is a flexible nasolaryngoscopy view ?and which is a flexible nasolaryngoscopy view ?
Under Wedging in Cancer Larynx
120%
120%
Will You Block The Arytenoids after 60Gy
Three Field Technique
Three Field Technique
Preferential 2:1
Stoma Story
Where do you Prescribe?
Where do you Prescribe?
SupraGlottic Larynx
Skull Base or NotSkull Base or Not
R NECK CTV
GTV
CTV
LT NECK CTV
L3
LT ANGLE DOWN (LLO)
When angle down technique we have to Increase the length of the field
Angle Down
RLOLLO
Target
Sup
Inf
Angle Down
Sup
Inf
Anterior Skin lesion
Clothes Clamp
Clothes Clamp Another use?
Less Oral Mucosa
LOOK HERE CAREFULLY
)Waldron et al 2003(
GTV
How to Solve this problem.
How Can You Determine the Energy for Electron beam
Separation=12cm
Spinal Cord
Take care for neck asymmetry
Spinal CordSpinal Cord
•Tonsil? What’s the difference between a Lymph node and the tonsils?
•From where coming the Squamous cell carcinoma if its only lymphoid tissue.
•Anterior and posterior pillars?
•palatoglossus and palatopharyngeus muscles?