Multidisciplinary approaches on chest tumors Radiation Oncology Case

Multidisciplinary approaches on chest tumors Radiation Oncology Case Reports

Name: A. E. DOB: 1942 Metastatic NSCLC T 1 N 2 M 1 G 3 • History: Metastatic NSCLC (diagnosis 2000) - initial stage T 1 N 2 M 1(multiple tumors in different lobes RUL 3 cm, RLL 2 cm, multilevel N 2 )

Name: A. E. DOB: 1942 Metastatic NSCLC T 1 N 2 M 1 G 3 • History: Metastatic NSCLC (diagnosis 2000) - initial stage T 1 N 2 M 1(multiple lung tumors in different lobes) - 6 cycles Carboplatin/Navelbine 2000 - mediastinal tumor progression 2001. no further treatment - clinical and radiological progression with SOB 2005

Name: A. E. DOB: 1942 Metastatic NSCLC T 1 N 2 M 1 G 3 • History: Metastatic NSCLC (diagnosis 2000) - initial stage T 1 N 2 M 1(multiple lung tumors in different lobes) - 6 cycles Carboplatin/Navelbine 2000 - mediastinal tumor progression 2001. no further treatment - clinical and radiological progression with SOB 2005 - Tarceva 05 -09/05, - PD (lung parenchyma) • Status: current problems: a) post-stenotic pneumonia b) singular brain metastasis right parietal with perifocal oedema

Name: A. E. DOB: 1942 Metastatic NSCLC T 1 N 2 M 1 G 3 • History: Metastatic NSCLC (diagnosis 2000) - initial stage T 1 N 2 M 1(multiple lung tumors in different lobes) - 6 cycles Carboplatin/Navelbine 2000 - mediastinal tumor progression 2001. no further treatment - clinical and radiological progression with SOB 2005 - Tarceva 05 -09/05, - september PD (lung parenchyma) • Status: current problems: a) post-stenotic pneumonia b) singular brain metastasis right parietal with perifocal oedema • Radiotherapy Concept:

Name: A. E. DOB: 1942 Metastatic NSCLC T 1 N 2 M 1 G 3 • History: Metastatic NSCLC (diagnosis 2000) - initial stage T 1 N 2 M 1(multiple lung tumors in different lobes) - 6 cycles Carboplatin/Navelbine 2000 - mediastinal tumor progression 2001. no further treatment - clinical and radiological progression with SOB 2005 - Tarceva 05 -09/05, - september PD (lung parenchyma) • Status: current problems: a) post-stenotic pneumonia b) singular brain metastasis right parietal with perifocal oedema • Radiotherapy Concept: a) palliative RT to mediastinum and primary lung tumour with 10 x 3 Gy b) whole brain radiotherapy with 10 x 3 Gy followed by a boost of 2 x 3 Gy to the singular metastasis (4 fractions a week)

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3 • PTV-Standard: a) tumour mass (PT and involved Ly. N-regions) + 1 cm margin in all directions b) whole brain homogenous; boost to brain metastasis with a 2 cm margin including tumour oedema • Deviation from standards / Reason: a) due to the large treatment volume a compromise of the PTV was made for better lung protection -> Not all visible parenchymal tumour lesions included b) no deviation • Case discussion could include role of radiation for brain metastases: Armstrong JG. , JCO, 1994. Treatment of brain metastasis. Mintz AP. , JAMA, 1998. Postoperative radiotherapy in single brain metastases. Patchell RA. , JAMA, 1998. Controversies in management of brain metastases. Chan AW. , Cancer, 2001. Review of initial management of brain metastases. Sneed PK. , Radiat Oncol Biol Phys, 2002. Status at last f/u (5 months after tt): Primary tumor: „PR“/minor response (-50% atelectatic areas and tumor) on Chest X-Ray, no local clinical sy. Brain metastases: no clinical symptoms, no steroids needed, no CT-Scan performed

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3

Name: A. E. DOB: 1942 Metastatic Bronchus-Ca T 1 N 2 M 1 (lung) G 3

Name: B. H. DOB: 1941 SCLC extensive disease • Diagnosis / Histology: SCLC of the right lower lobe (diagnosis in 2006) - extensive disease (multilevel, bilateral, med. lymph nodes; 1 (2 cm) metastases left liver lobe)

Name: B. H. DOB: 1941 SCLC extensive disease • Diagnosis / Histology: SCLC of the right lower lobe (diagnosis in 2006) - extensive disease (mediastinal lymph nodes, 1 livermetastases) - 6 cycles Carboplatin / Etopophos 6 -9/06, PR after 3 cycles, progression after 6 cycles - 10/06: progression of mediastinal lymph nodes and intrapulmonary tumour

Name: B. H. DOB: 1941 SCLC extensive disease • Diagnosis / Histology: SCLC of the right lower lobe (diagnosis in 2006) - extensive disease (mediastinal lymph nodes, 1 metastases in liver) - 6 cycles Carboplatin / Etopophos 6 -9/06, PR after 3 cycles, progression after 6 cycles - 10/06: progression of mediastinal lymph nodes and intrapulmonary tumour • Status: Current problems: locoregional tumor progression

Name: B. H. DOB: 1941 SCLC extensive disease • Diagnosis / Histology: SCLC of the right lower lobe (diagnosis in 2006) - extensive disease (mediastinal multilevel, bilaterla lymph nodes, 1 metastases in liver) - 6 cycles Carboplatin / Etopophos 6 -9/06, PR after 3 cycles, progression after 6 cycles - 10/06: progression of mediastinal lymph nodes and intrapulmonary tumour • Status: Current problems: locoregional tumor progression • Radiotherapy Concept: RT of the mediastinum and the primary lung tumor with 22 x 1. 8 Gy = 39. 6 Gy followed by 10 x 1. 8 Gy = 18 Gy without spinal cord. Total dose 59. 6 Gy. •

Name: B. H. DOB: 1941 SCLC extensive disease • Diagnosis / Histology: SCLC of the right lower lobe (diagnosis in 2006) - extensive disease (multiple bilateral mediastinal lymph nodes, 1 2 cm met. in left liver lobe) - 6 cycles Carboplatin / Etopophos 6 -9/06, PR after 3 cycles, progression after 6 cycles - 10/06: progression of mediastinal lymph nodes and intrapulmonary tumour • Status: Current problems: locoregional tumor progression • Radiotherapy Concept: RT of the mediastinum and the primary lung tumor with 22 x 1. 8 Gy = 39. 6 Gy followed by 10 x 1. 8 Gy = 18 Gy without spinal cord. Total dose 59. 6 Gy. • PTV-Standard: CTV: tumour + 0. 6 – 0. 8 cm margin in all directions and regional lymph nodes PTV: transversal: GTV + 1 cm, axial: GTV + 1. 5 – 2 cm

Name: B. H. DOB: 1941 SCLC extensive disease • Deviation from standards / Reason: none • Literature: - Jeremic et all, Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small-cell lung cancer: a randomized study. JCO 1997: 893900. - Murray et all, Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. JCO 1993: 336 -344 - Pignon et all, A metaanalysis of thoracic radiotherapy for small-cell lung cancer. NEJM 1992; 327: 1618 -24 - Pignon et all, Role of thoracic radiotherapy in limited-stage small-cell lung cancer: quantitative review based on the literature versus meta-analysis based on individual data. JCO 1992; 10: 181920 - Takada et all, Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Cisplatin and Etoposide for Limited-Stage Small-Cell Lung Cancer: Results of the Japan Clinical Oncology Group Study 9104. JCO 2002: 3054 -3060 Status at last f/u 3 months after tt: Primary tumor and regional lymphnodes: partial remission (60% on CT), no clinical symptoms Liver metastasis: tumorgrowth 20% on CT (left lobe), 2 nd small suspicious lesion (caudate lobe)

Name: B. H. DOB: 1941 SCLC extensive disease

Name: B. H. DOB: 1941 SCLC extensive disease

Name: B. H. DOB: 1941 SCLC extensive disease

Name: B. H. DOB: 1941 SCLC extensive disease