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Mostafa El-Haddad
MD., FRCR., HMD.
Tips and
Tricks ™
By
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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).
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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.
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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.
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General
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Positioning
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Head Rest
Trick!
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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
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•Supine Position.
•Lateral position
•Open neck position.
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Lateral or Open Neck
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Extension is it Necessary?
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Brain inclusion with more extension.
Neck to be included or not.
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Neutral Chin Position
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Neutral Position
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Maxillary Sinus
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Another Method
Gantry
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Head supportsHyperextension can be achieved by elevating the chest without make a strain on the head.
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When Extension is Not Necessary?
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Oral Cavity
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Pushing The lip forward in Tongue cancer But avoid tissue equivalent material
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Tongue depressor may be different
Spot the difference?
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Tongue BiteOr
Mouth Opener
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Shielding Stents
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Open Mouth or Closed when
and why?
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Hypopharynx
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With Tongue Bite
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Without Tongue Bite
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Energy Used
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Ipsilateral neck failure as first event (13%) than patients treated by 60C0
and 4 MV (9%).This difference was not statistically
significant.
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Beam Spoiler
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Larynx
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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 ?
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Under Wedging in Cancer Larynx
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120%
120%
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Will You Block The Arytenoids after 60Gy
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Three Field Technique
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Three Field Technique
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Preferential 2:1
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Stoma Story
Where do you Prescribe?
Where do you Prescribe?
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SupraGlottic Larynx
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Skull Base or NotSkull Base or Not
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R NECK CTV
GTV
CTV
LT NECK CTV
L3
LT ANGLE DOWN (LLO)
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When angle down technique we have to Increase the length of the field
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Angle Down
RLOLLO
Target
Sup
Inf
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Angle Down
Sup
Inf
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Anterior Skin lesion
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Clothes Clamp
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Clothes Clamp Another use?
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Less Oral Mucosa
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LOOK HERE CAREFULLY
)Waldron et al 2003(
GTV
How to Solve this problem.
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How Can You Determine the Energy for Electron beam
Separation=12cm
Spinal Cord
Take care for neck asymmetry
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Spinal CordSpinal Cord
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•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?