LOW DOSE CRANIOSPINAL IRRADIATION (CSI) USING VMAT , RADIATION FOR GRAVES DISEASE, AND RADIATION FOR MEDIASTINAL GRAY ZONE LYMPHOMA

Guiding your journey through cancer care Dr. Vimoj J. Nair

RADIATION ONCOLOGY CASE ROUNDS

Dr. Vimoj J. Nair

Dept. of radiation oncology

Prince Edward island cancer treatment Centre,

Charlottetown


OBJECTIVE

• 3 cases

• Adult Germinoma

• Graves Orbitopathy

• Mediastinal Gray Zone Lymphoma


RADIATION TRIVIA

Numéro 1


WHAT’S SPECIAL ABOUT THIS WEEK?

• held annually in the week that contains

November 8,

• the anniversary of the founding of the x-

ray by Wilhelm Roentgen in 1895

• The Essential Link: Where advanced

Technology Meets Compassionate

Care.


ANY THING ELSE SPECIAL ABOUT THIS WEEK?

• November 7

• IDMP 2014: Recognizing the Great Contribution of Medical

Physics to Medical Imaging Progress

• 1867, Marie Curie, known for her pioneering research on

radioactivity, was born in Poland.


ANY THING ELSE SPECIAL ABOUT THIS WEEK?

• National Radiation Protection Professionals Week

• week of 2–8 November 2014


NEXT WEEK IS SPECIAL TOO!!


CASE 1

Adult Supratentorial germinoma



VMAT BASED LOW DOSE CSI (CRANIOSPINAL

IRRADIATION)

• 25 Gy in 20 Fractions to Brain and spine

• 40 Gy in 20 – Tumor boost


MRI BEFORE CSI POST TREATMENT MRI


MRI BEFORE CSI POST TREATMENT MRI


SIDE EFFECTS


TRIVIA QUESTION NO 2


WHOSE’S RING IS THIS?

A. Madame Curie

B. Pierre Curie

C. Mrs. Roentgen

D. Mrs. Varian

E. Mr. Cobalt


CASE2 GRAVES ORBITOPATHY


GRAVES ORBITOPATHY


GRAVES ORBITOPATHY/OPTHALMOPATHY/

THYROID EYE DISEASE

• 50% of patients with Graves disease

• Radiation therapy is done for disease refractory to

surgery/steroids

• Response

50-90% response rates




TRIVIA QUESTION NO 2


WHICH ACTIVITY EXPOSES YOU TO THE HIGHEST AMOUNT OF

RADIATION?

A. Smoking a pack of cigarettes a day

B. Gaming on an XBOX 360 with Kinect!

C. basic chest X-ray

D. Sipping on a medium sized coffee from Tim Horton’s daily


ANSWER

• Cigarettes contain polonium-210 and lead

• estimated that smoking a pack-and-a-half every day exposes a

smoker to a dose of radiation equivalent to 300 chest X-rays a

year

• Polonium is an alpha emitter. Poor penetration.

• * 1kg coffee = 1000 bequerel

* Royal Society of Chemistry, Radiochemical Methods

Group



CASE 3 MEDIASTINAL GRAY ZONE LYMPHOMA


MEDIASTINAL GRAY ZONE LYMPHOMA (MGZL)

• Type of lymphoma that is characterized by having

cellular features of both

• Primary mediastinal large b-cell lymphoma (PMBL)

• And classic hodgkin lymphoma of the nodular sclerosis

type (CHL-NS)


CASE HISTORY

• 34 year old

• Diagnosed 4 years ago

• Post chemo, post transplant

• Residual disease



2011 2012


2013 2014



ISRT


THANK YOU FOR YOUR PATIENCE!


Health & Medicine

LOW DOSE CRANIOSPINAL IRRADIATION (CSI) USING VMAT , RADIATION FOR GRAVES DISEASE, AND RADIATION FOR MEDIASTINAL GRAY ZONE LYMPHOMA