Mostafa El-Haddad

MD., FRCR., HMD.

Tips and

Tricks ™

By

Category 1 Priority;• SCC of the head and neck region.• SCC cervix.• Non-small cell carcinoma of lung.

Guidelines for the Management of the Unscheduled Interruption or Prolongation of a Radical Course of Radiotherapy (2nd Edition. 2002).

MD Anderson series showed that completed combined treatment (Surgery + Radiotherapy) in 11 weeks is better than 11 to 13 weeks and more than 13 weeks is the worst.

Why Head And Neck Is Special

•Very Complicated anatomy.

•Many risk organ in a very narrow space.

•Needs high precision.

•Patients in very bad shape.

•RCR report for priority.

General

Positioning

Head Rest

Trick!

A comfortable head support is one that tightly fits to the posterior surface of the head and neck and help the patient to maintain the position without straining.

The neck is rested but not the head, this open room

for a movement

•Supine Position.

•Lateral position

•Open neck position.

Lateral or Open Neck

Extension is it Necessary?

Brain inclusion with more extension.

Neck to be included or not.

Neutral Chin Position

Neutral Position

Maxillary Sinus

Another Method

Gantry

Head supportsHyperextension can be achieved by elevating the chest without make a strain on the head.

When Extension is Not Necessary?

Oral Cavity

Pushing The lip forward in Tongue cancer But avoid tissue equivalent material

Tongue depressor may be different

Spot the difference?

Tongue BiteOr

Mouth Opener

Shielding Stents

Open Mouth or Closed when

and why?

Hypopharynx

With Tongue Bite

Without Tongue Bite

Energy Used

Ipsilateral neck failure as first event (13%) than patients treated by 60C0

and 4 MV (9%).This difference was not statistically

significant.

Beam Spoiler

Larynx

1- Identify the anatomy and orientation. 1- Identify the anatomy and orientation. 2-Which is an indirect (mirror) laryngoscopy view 2-Which is an indirect (mirror) laryngoscopy view and which is a flexible nasolaryngoscopy view ?and which is a flexible nasolaryngoscopy view ?

Under Wedging in Cancer Larynx

120%

120%

Will You Block The Arytenoids after 60Gy

Three Field Technique

Three Field Technique

Preferential 2:1

Stoma Story

Where do you Prescribe?

Where do you Prescribe?

SupraGlottic Larynx

Skull Base or NotSkull Base or Not

R NECK CTV

GTV

CTV

LT NECK CTV

L3

LT ANGLE DOWN (LLO)

When angle down technique we have to Increase the length of the field

Angle Down

RLOLLO

Target

Sup

Inf

Angle Down

Sup

Inf

Anterior Skin lesion

Clothes Clamp

Clothes Clamp Another use?

Less Oral Mucosa

LOOK HERE CAREFULLY

)Waldron et al 2003(

GTV

How to Solve this problem.

How Can You Determine the Energy for Electron beam

Separation=12cm

Spinal Cord

Take care for neck asymmetry

Spinal CordSpinal Cord

•Tonsil? What’s the difference between a Lymph node and the tonsils?

•From where coming the Squamous cell carcinoma if its only lymphoid tissue.

•Anterior and posterior pillars?

•palatoglossus and palatopharyngeus muscles?