esmo preceptorship programme fileesmo preceptorship programme clinical history mr.a-52yr old...
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ESMO Preceptorship Programme
Carcinoma of tonsil
Dr.Chandima Vithanage(MBBS MD Clinical Oncology)
Tumor Type – Location – Date
ESMO PRECEPTORSHIP PROGRAMME
Disclosures
� No disclosures
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
CT Scan ctd
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
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
ESMO PRECEPTORSHIP PROGRAMME
95% Dose to the CTV₅₄
ESMO PRECEPTORSHIP PROGRAMME
95%Dose to CTV₅₄
ESMO PRECEPTORSHIP PROGRAMME
95%Dose to CTV₆₅
ESMO PRECEPTORSHIP PROGRAMME
DVH
ESMO Preceptorship Programme