Peds/Lymphoma/Sarcoma (new threads)

WOULD YOU TREAT THE IPSILATERAL NODAL STATIONS?

Sat, 19 Feb 2011 08:00:46 +0000

14 year old girl with a parameningeal embryonal rhabdomyosarcoma

post-op —>4 cycles of adjuvant chemotherapy (VAC/VAI)

plan to start radiotherapy at the earliest omitting AMD and Etoposide from her chemotherapy in consultation with the medical oncologist since she has a) large residual tumor b) orbital extension c) limited intracranial extension in ipsilateral temporal lobe —she is IRSG post-surgical Group 3 .

Planning CT scan showed the residual tumor with extension as mentioned above ( image attached)and we are trying to protect as much of the visual pathway and brain as achievable.

Pre-op CT/MRI showed no evidence of lymph node involvement -not sampled surgically.

WOULD YOU INCLUDE IPSILATERAL NODAL STATIONS IN THE CTV —IF SO , WHAT LEVELS? I could not find literature supporting prophylactic nodal irradiation in this scenario .

I am planning to deliver 50.4 Gy @ 1.8 in 28 # .

Extranodal lymphoma

Thu, 27 Jan 2011 11:39:52 +0000

Case Capsule:
36yr/M, NHL with RVD
HOPI:
(24.01.08) Laparoscopic resection & anastomosis: HPR:NHL small intestine, one margin positive, hyperplasia in 3 mesenteric nodes— CT (24.11.08)-14.6x12.6x11.9cm R lumbar & iliac region mass involving anterior abdominal wall musclesunderwent surgery, no details-advised chemotherapy but chemo not taken as medical oncologist was not ready for chemo along-with Anti-RVD-so conued Rx for RVD-recurred— (July'10) trucut biopsy at Mangeshkar hospital-DLBCLMib-1 index-60%, bone marrow uninvolved-chemotherapy 6#-interval CT after 5#(27.11.10) 5.9x4x5.4cms minimally enhancing soft tissue mass in right latral abdominal wall inseperable from external oblique musclein R lumbar regionjust above the iliac crest with 3.5x3.2x2.7 cms lesion on left side along left superolateral aspect of prostate, L seminal vesicle cannot be seperately visualised, multiple small mesenteric and retroperitoneal lymph nodes—Post-chemo-CT showed masses resp 5x4.8x6.1cm and 3x3x2.6cms-mass palpable in R lumbar region-
My opinion:WAR+Boost vs 2nd line chemotherapy sos RT
Please Opine—

Optic glioma

Wed, 19 Jan 2011 12:11:29 +0000

Greetings from Pune!
To opine on the following case.

Case Capsule:
Age: 21/2 yrs
Optic glioma, dimination of vision on one side
Case disscussed by Neurosurgeon on phone/no surgical intervention
My opinion was: to wait at least 6mths (should we wait for completion of 3yrs)
Nsx:what we will do if it progresses on other side meanwhile.

Regards!

Dr.Shailesh S. Shende

MBBS, MD (Radiation Oncology)

Consultant Radiation Oncologist,

Vimal Lalchand Mutha Cancer Centre,

Deenanath Mangeshkar Hospital & Research Center,

Erandwane, Pune-411004

Phone no - +91-(20)-66023000, Extn 2910

Fax - +91-(20)-25420104

Mobile No - 09890609830
Email - oc.liamffider|ednehshseliahs#oc.liamffider|ednehshseliahs

MPNST of the brachial plexus

Wed, 15 Dec 2010 18:19:58 +0000

A 57 yr old lady presents with a supraclavicular swelling and some tingling near her left elbow.
MRI reveals a mass that is indistinguishable from the brachial plexus about 5x 5 cm in size
A neurosurgeon operates - with piecemeal excision. HPE reveals MPNST - high grade.
Post op MRI at 4 wks reveals a residual signal abnormality - about 2.5 x 3 cm. An independent surgical consult is taken - surgeons opine that this is likely some residual disease and some post-op change but repeat surgery is unlikely to clear the residual.
Patient is referred for post-op RT.
Question: What dose - given that there is R2 resection but this is on the brachial plexus. And is there any role of chemotherapy?

Textbook of Neuroblastoma

Sun, 19 Sep 2010 17:07:59 +0000

I came across this textbook on Neuroblastoma. I hope that this benefits all of the members :)

http://www.scribd.com/doc/37727021/Textbook-of-Neuroblastoma-by-Cheung-Springer-Publications

Wilm's tumor relapsed with pulmonary mets

Tue, 24 Aug 2010 16:11:02 +0000

1) what should be the mode of diagnosing the pulmonary mets radiologically - for considering to give WLI?
2) If there is a relapse in lungs after completing prior treatment for abdominal disease - what is the management?
3) if after chemotherapy the relapsed lung metastasis disappear radiologically is it required to give WLI in relapsed cases?

Childhood HD

Mon, 09 Aug 2010 12:09:46 +0000

5 year old boy. presented with b/l neck nodes. biopsy - HD classic LP. received 4 MOPP & 4 ABVD. CR on PET-CT after 7th cycle.

Initially had right neck node 6X4cm and left 3X 2 cms. also had spleen involvement & was staged as IIIBs.
Any role for radiotherapy - what sites and dose?

Plasmacytoma with ? LN involvement

Mon, 09 Aug 2010 08:09:04 +0000

53/M
HIV/HBsAg: Non reactive
Lt pleural based mass with some erosion of 5th rib. Enlarged precarinal and pretracheal LN largest 16mm
Mass bx: s/o Plasmactoma
SIEP: No band for IgG, IgA, IgM but band seen for lamda chain.
B2 microglobulin raised (7462ngml: N 1010-1730)
ESR 80 mm
Skeletal survey: No other lesions
BM: Uninvolved
LN tissue diagnosis not available

How common is LN involvement?

Med Onc has planned Thal Dexa
Should we treat LN also? if yes to what dose? what volume (only GTV+margin or entire mediastinum)

Ewings sarcoma

Sun, 06 Jun 2010 07:16:00 +0000

3 year old child presents with chest pain and dyspnoea a year back, investigated with CECT chest- 7 x 8 cm mass lesion in the posterior mediastinum with ? involvement of the D4,D5 neural foraminal space,?PNET, underwent total resection 1 year back and was on VAC + IE chemotherapy since then, post-op CT- s/o no residual, now referred for radiotherapy,
1)Is there any role of RT now keeping in view young age of the patient?
2) Role of PET in this case?
3) If there is role of RT consideration for gap between surgery and RT?
4) if RT is given, volumes that are to be taken?

please advice

Dr.Yugandhar Sarma
Senior resident
NIMS,
Hyderabad

Recurrent Benign synovioma

Mon, 26 Apr 2010 10:48:42 +0000

30/M
2006: Lt thumb soft tissue mass at proximal phalynx near web.
Excion done
HPR: NA
2008: Recurrent lesion
Excision done
HPR:Giant cell tumour of tendon sheath ( No e/o malignancy)
2010:Recurrent lesion
Excision done with silastic implant placement
HPR:Giant cell tumour of tendon sheath ( benign synovioma)
Will RT help prevent further recurrence?

MPNST

Sat, 24 Apr 2010 06:08:42 +0000

27/M
Huge STS involving 3/4 th of foot.
B/K amputation done.
HPR: MPNST (pT 25*12 cm)
Nerve cut end free
CT Thorax: No mets.

Any evidence on adjuvant RT? as there is no tumour bed left (its wide wide margin)

Paed HD in CR

Thu, 22 Apr 2010 07:35:11 +0000

13/M
Rt cervical LN pathy
B symtoms+. individual LN non bulky althoough comglomerate mass
PET confirmed involvement of only Rt cervical region
Post 3# ABVD PET shows CR
Recieved additional 1# ABVD.
What should be the dose of RT. NCCN has given a range of dose from 20-30 Gy.
TMH protocol would say 19.8 Gy

pediatric ependymoma

Mon, 22 Feb 2010 15:07:07 +0000

one and a half year old girl,presented with left hemiparesis.MRI showed brainstem/CP angle ICSOL.Surgical decompression done on 12.2.10.Histopathology Anaplastic ependymoma.Now referred for RT.Awaiting postop MRI(not done in immediate postop period).Am planning CSF and only local RT if CSF negative upto 54 Gy (to be started in 2 nd week of March).Opinions/differences invited.

Sarcoma

Mon, 22 Feb 2010 05:02:30 +0000

1) Pre-op RT vs post-op RT.
2) STS Brachytherapy is there any role these days with IMRT around ?
what is the standard ? What is your institutional practice and why ?

Retinoblastoma

Sat, 02 Jan 2010 08:25:30 +0000

5 year old boy diagnosed of Left EYE RETINOBLASTOMA.
MRI revealed optic nerve involvement. Bone Marrow showed 4 % small round cells. Bone scan was normal.

The child received 6 cycles of carboplatin , vincristine and etoposide . After this he was ennucleated . All this was done at Sankar Netralaya. Post operative HPR not available with us.

RT role, field and dose.