ENT examination Lesion on the left base of tongue Lymph nodes level II amp IV on the left side Biopsy of nodes and base of tongue lesion Grade 3 squamous cell carcinoma p16 positive What further information do you require ID: 912320
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Slide1
Question 1
Slide236 year old woman presents with a lump in left neck and difficulty opening her mouth.
ENT examination:
Lesion on the left base of tongue.
Lymph nodes level II & IV on the left side.
Biopsy of nodes and base of tongue lesion:
Grade 3 squamous cell carcinoma. p16 positive.
What further information do you require?
Slide3Comment on the scans.
Slide436 year old woman presents with a lump in left neck and difficulty opening her mouth. PS 1.
Staging: T4a N2b M0 G3 p16+ve SCC of the tongue base.
Left levels II & IV cervical lymphadenopathy.
Right neck clear
What treatment would you recommend and why?
Slide536 year old woman presents with a lump in left neck and difficulty opening her mouth. PS 1.
Staging: T4a N2b M0 G3 p16+ve SCC of the tongue base.
Left levels II & IV cervical lymphadenopathy.
Right neck clear
She receives 3 cycles of
neoadjuvant
chemotherapy with excellent symptomatic and clinical benefit.
It is decided to proceed with
chemoradiotherapy
.
Describe your technique, dose & fractionation.
Slide636 year old woman PS 1.
Staging: T4a N2b M0 G3 p16+ve SCC of the tongue base.
Left levels II & IV cervical lymphadenopathy.
Right neck clear.
Outline your CTV/s on the slice below.
GTV outlined in blue
.
Slide7Comment on the plan below. Would you accept this plan?
CTV1 – high dose 65Gy
CTV2 – elective dose 52Gy
110%
isodose
for CTV1
95%
isodose
for CTV1
90%
isodose
for CTV1
Slide8Question 2
Slide989 year old man with a lesion on the left ear. PS 2.
What is your initial management?
Slide1089 year old man with a lesion on the left ear. PS 2.
Biopsy: grade 3 squamous cell carcinoma.
MRI H&N: tumour localised to external ear canal & pinna
no bone invasion, no lymphadenopathy
What are the treatment options?
Describe the advantages and
disadvantages of each approach.
Slide11Anterior Posterior
tragus
pinna
tragus
pinna
89 year old man with a lesion on the left ear. PS 2.
Biopsy: grade 3 squamous cell carcinoma.
MRI H&N: 7mm thick tumour localised to external ear
canal & pinna no bone invasion, no nodes.
The skin MDT recommends
radiotherapy.Describe your radiotherapy technique, dose & fractionation.Tumour red, section along blue line7mm
Slide12Anterior Posterior
tragus
pinna
7mm
It is decided to treat with electrons. Draw the treatment arrangement.
Slide132 years post radiotherapy aged 91 he had an excellent response to radiotherapy but there is a painful swelling in his neck.
Biopsy confirms metastatic
squamous cell carcinoma.
What would you do?
Slide14Comment on the scan
?
R L
Slide1591 year old man. Previous RT for ear SCC.
Now PS 3. Painful fixed enlarging lump in neck.
MRI: solitary left level II lymph node, extending 4.5cm deep to the skin.
Biopsy: metastatic SCC
What is your management?
R L
Slide1691 year old man. Previous RT for ear SCC. PS 3.
Painful enlarging fixed lump in neck. MRI: solitary left level II LN
Maximum depth 4.5cm from skin.
It is decided to treat with RT.
Previous RT - 55Gy/20
Describe your radiotherapy
technique.
What is your dose
and fractionation?
R L
Slide1791 year old man. Previous RT for ear SCC. PS 3.
Painful enlarging fixed lump in neck. MRI: solitary left level II LN
Biopsy: SCC
It is decided to treat with RT.
Previous RT - 55Gy/20
95% isodose outlined in
gold
.
Lymph node target =
blue circle
Draw on your radiotherapy field & describe your margin.