50+ , active male ,swelling around left knee,subtotal synovectomy done,HP-Pigmented Villonodular synovitis .Has been advised radiotherapy.Opinion of house please.
There seems to be a role of RT to a low dose to control growth and improve joint function.
See this recent publication from Stanford.
http://www.ncbi.nlm.nih.gov/pubmed/19211195
Doses given were around 30-34Gy in 1.8-2Gy per fraction and the functional results were great. 25% rate of failure after RT.
Hi Hari, Very tricky case, NO RIGHT OR WRONG ANS. I remember seeing one at PMH with the Sarcoma team, our patient had multiple recurrences and so we elected to treat. No one knows what dose to give, I think with the new paper that Indranil has quoted. 30-35 Gy conventional fractionation should be enough.
In your patient, you need to talk to your patient and the orthopedic surgeon about possible second resection and pro/con's of RT. Observing your patient is also an option and deffer RT for recurrence.
HI,
i would like to share our experience with two cases of pigmented villonodular sinovitis we treated at AHRCC. one a 20 year old female with PVNS of left wrist joint, received postop(R0) Radiation to a dose of 40 Gy in 20 Fractions, on follow up for more than 3 years without any local recurrence.The other patuent was a 55 year old male with sacral PVNS, presented with para paresis and pain …received palliative radiation to a dose of 30Gy in 10 #, with good pain releif that sustained for > 6months , thereafter the patient was lost to follow up. so It seems that radiation does works
Hi Anish, Can you tell us more about the functional outcome of your first patient ?
Thanks for the information.
Hi guys,
Can you please help me with CT based contouring of PVNS POST OP. any guidelines? and dose volume parameters?
Hi Sammy could you make this a new post with some radiological pics and details about patient.