esmo preceptorship programme fileesmo preceptorship programme clinical history mr.a-52yr old...

ESMO Preceptorship Programme

Carcinoma of tonsil

Dr.Chandima Vithanage(MBBS MD Clinical Oncology)

Tumor Type – Location – Date

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Disclosures

� No disclosures

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Clinical History

� Mr.A-52yr old gentleman

� P/C- Right sided neck lump, R/tonsillar mass and painful

swallowing of one month duration.No weight loss.

� PMH-Hypertension for 5 years,dyslipidaemia for 3 years.

Both well controlled with medication.

� S/H-Married.Farmer.Lives with wife .Smoker 3-5/Day for

32yrs.Social drinker.

-Two children 25M and 22F both married.

-Good family support

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Clinical Examination

� PS -0/1

� Oral cavity-Ulcerative lesion in R/tonsillar fossa

extending upto uvula and involving base of the

tongue,epiglottis and vallecular.

� Neck-Firm R/S level Ib,II,III cervical nodes largest

4×3cm and fixed.No left side cervical nodes.

� Clinically not pale

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Investigations

� CT Scan Head and Neck-

Minimally enhancing soft tissue mass in right

tonsillar fossa 3.5×2.4cm.Base of epiglottis,base of

tongue and vallecula is invaded. Mass invades

submandibular gland but not pterygoid muscles.No

bone erosion.Multiple enlarged R/cervical nodes

level Ib,II,III largest level II 3.8cm×3.5cm

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CT Scan ctd

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CT Scan ctd

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Investigations ctd

� FNAC R/Cervical LN- Secondary deposits of

carcinoma

� R/Tonsilar biopsy-Features of a moderately

differentiated squamous cell carcinoma

� CXR-Normal

� Basic haematology and biochemical assessment

Diagnosis-SCC of R/tonsil T3N2bM0 Stage III

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Management

� Discussion at the MDT- Chemoirradiation with cisplatin

� Diagnosis was conveyed to the patient,Managementplan was discussed with the patient.Acute and long term side effects discussed and pt consented

� Referred for Counselling –Regarding abstinence from smoking

� Referals to speech and language therapist and dietician was arranged

� Assessment of dental hygiene,Insertion of PEG tube

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Chemoirradiation

� IV Cisplatin 40mg/m² weekly at least 5 doses,1/2-1hr before radiotherapy.

� Radiotherapy-External beam IMRT Fixed fields.

� High dose CTV-GTVp+GTVn+R/S Level Ib,II,III,IV,V+oropharynx

� Low dose CTV-L/S Level Ib,II,III,IV,V

� Dose- PTV₆₅-65Gy in 30 # ,PTV₅₄-54Gy in 30#

� OAR-Parotids,Spinal cord,Brain stem

� Treatment verification,weekly review of patient

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95% Dose to the CTV₅₄

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95%Dose to CTV₅₄

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95%Dose to CTV₆₅

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DVH

ESMO Preceptorship Programme