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Portfolio Clinical II Case Study 1
Portfolio Clinical II Case Study 1
Patient5
MRN: 907972614
61 Y/O
Caucasian
Male
Treated on the MXE
Consult was September 2013
Treatment soon after.
General Medical Hx 5
Overall healthy individual
Prior to CA had no major medical Hx
NKDA
Some surgeries through out his life
Hernia (at age 4)
Ankle surgery (2005)
Brain Surgery for GBM (Resection @ RMH 9/2013)
No Hx of Previous Radiation or Chemotherapy
Presenting Symptoms 5
Pt goes to RMH ED with:
Etiology1
Origin of primary CNS Tumors are mostly
unknown:
Environmental Factors - Chemicals, Pesticides, Ionizing
radiation and electromagnetic fields.
Life Style Factors cell phones, nitrates, hair dyes and
smoking.
Medical Conditions drugs, viral infections, AIDS
Family Hx indicates none of these factors directly relate
to him.
Epidemiology3
The National Cancer Institute estimates 22,910
adults will be diagnosed with brain and other CNS
tumors in 2012.
(60%) 13,700 of these diagnoses will result in
death.
GBM = 15% of all brain tumors
primarily occurs in adults 45 to 70 years old.
Prognosis1,2,5
Mid-line shift
to the left
Tumor
Metastasis
Grade
G1, well differentiated, better outcome
G2, moderately differentiated
G3, poorly differentiated
G4, undifferentiated, worse outcome
All GBMs = Grade IV
Used to be whole
brain, now with CT
and MRI limited
radiation fields
covering the lesion
and a margin is
advocated. If it is
brain mets from
another site wholebrain is then prefered.
Pt Treatment Plan
Field Design5
Field
Gantry
Angle
Segments
MUs per
Angle
180
40
220
37
260
33
300
30
340
57
20
47
90
30
46
45
145
40
330 Total
Mus
Couch
Critical Structures 5
Patient Positioning 5
IMRT
treatment
collimators
define
field size
to match
isodose
curves
Skin irritation
Hair loss
Brain swelling (steroids)
Fatigue rest PRN
Vomiting
Nausea Tx with anti-emetics
Decreased Appetite observe
Abnormal Taste and Smell some irritation from
radiation in oral cavity, this should subside in 1-2
months.
Hearing Loss
Vision Changes
Short Term Memory Loss
Cognitive Dysfunction
Secondary cancer Formation
As of the patients follow-up visit in 12/2013, he was not
experiencing any late side effects.
In Conclusion
This patient has been thru a lot. He remains in
good spirits but fatigued most of the time. He has
not seen much improvement in his symptoms, but
also has not demonstrated new symptoms or
problems. Most recent MRI shows no
enhancement suggestive of progressive disease.
He celebrates his 62nd birthday on February 18th.
References
1. Reviews CT. e-Study Guide for: Principles and Practice of Radiation
Therapy by Charles Washington, ISBN 9780323053624. Cram101; 2012.
2. Vann AM, Dasher B, Wiggers N. Portal Design in Radiation Therapy, 3rd
Edition. 2013.
3. Available at: http://www.aans.org/Patient Information/Conditions and
Treatments/Glioblastoma Multiforme.aspx. Accessed January 26, 2014.
4. Available at: http://emedicine.com. Accessed January 26, 2014.
5. IHIS
6. Carter CE, Veal BL. Digital Radiography and Pacs. Mosby Incorporated;
2010. Might not use this one it is PACS book.
7. Available at: http://neurosurgery.mgh.harvard.edu/newwhobt.htm.
Accessed January 28, 2014.
8. Available at: http://www.mypacs.net/cases/62178343.html. Accessed
February 1, 2014.