Case Presentation

Abbey Hassmann October 11, 2013

Patient Demographics
S 69 years old
S Male

S RT #: 13-1550
S STX, The James

Symptoms
S

Typical Symptoms
S Epitaxis S Blockage of a nostril S Runny nose on one

Vertical diplopia -Double vision

S S

Sinus congestion Tinnitus -ears ringing

side
S Symptoms that can

S S S S S S

Numbness of left lower face and lip Swollen left eye lid Dizziness Headaches Ear pain V2 numbness

indicate an advances cancer tumor are:

S A persistent

headache
S Changes in

vision or double vision

Sinuses
S Sphenoid
S Ethmoid S Maxillary S Frontal

Invades floor of orbit, soft tissues of the face, left nasal cavity, left maxillary bone, Left orbit, left extraocular muscles, and anterior zygomatic arch

IVA T4 M0 N0

Staging and Histology

S IVA (T4 N0 M0) S Sinonasal undifferentiated carcinoma of

the left maxillary sinus

S -most are squamous cell or adeno Ca or

melanoma
S 4.5x 5.2 x 4.2 cm
Invades floor of orbit, soft tissues of the face, left nasal cavity, left maxillary bone, Left orbit, left extraocular muscles, and anterior zygomatic arch

Past Medical/Social History

S Manager at a pesticides plant S Prostatectomy in 2005 for precancerous

cells
S Non-smoker

S Non-drinker
S Chronic Sinusitis

Etiology
S Exposure to certain workplace chemicals or dust.

The following jobs are the riskiest:

-Work in Furniture-making, Sawmill, Carpentry, Shoemaking, Flour mill or bakery work.
S S S S

Being male. Age more than 40 years. Smoking; Tobacco use. Chronic sinusitis.

Diagnostic Tests
S Nasal endoscopy S S S

CT/MRI Biopsy Chest x-ray

S PET CT

PET Scan

Invades floor of orbit, soft tissues of the face, left nasal cavity, left maxillary bone, Left orbit, left extraocular muscles, and anterior zygomatic arch

Treatment
S One cycle of Chemo (started 7/2) S Cisplatin and Etoposide S -tumor regrowth S Second Cycle of Chemo (7/23)

-Carboplatin and reduced dose of Etoposide

S Concurrent chemo (Third Cycle) and Radiation Therapy S -7000 cGy S -200 per fx S # of treatments? S 7 angles (270, 310, 350, 30, 70, 110, 150) S 6 mV S Conebeam daily, align to orbits S Possible Surgery (MRI scheduled for 10/10)

Background info
S Rescanned after 2 treatments

S -New mask, no new plan

S Rescanned again around 9/24 S -Same mask, new plan S End 10/2

Sim photos 1

Large Aquaplast Mask Custom Headrest Knee sponge Arms on abdomen holding ring

VSIM 1

Sim photos 2

DVH 1

DVH 2

DVH 1

DVH 2

Discussion

S Why I picked this patient

Side Effects
S Acute: mucositis, erythema, nasal dryness, Xerostomia
S Xerostomia- tried artificial saliva but was not tolerated

well so he drank water S Had PEG tube placement mid-treatment

S Late: xerostomia, optic pathway injury,

osteoradionecrosis, cataracts, radiation induced hypopituitarism

Critical Structures
S

Lacrimal gland < 30 40 Gy

)

(dry eye)

S Lens of the eye < 10 Gy (cataracts

S Retina

< 45 Gy

(vision loss) < 45 Gy (vision difficulties)

S Optic chiasm S

Brain

< 70 Gy (necrosis)

S Mandible < 60 Gy (osteoradionecrosis)

Routes of Spread
S

Tissue: The cancer starts to invade the adjacent normal tissue Lymphatic system: retropharyngeal nodes, submandibular, jugular chain and possibly cervical lymph Blood: Cancer cells invade veins, capillaries and reach different areas Organs like lungs may even become the destination for these cells. Hence the importance of chest x-rays

Epidemiology
S Maxillary Sinus Cancer is the most common of the

sinuses (70%) but overall very uncommon (1%)

S Greater in males than females. Men are affected

one-and-one-half more often then women.

S The disease is more common in people between

45 and 85 years of age.

Survival rates
S Stage

5-year relative 63% 61% 50% 35%

5 year survival disease free of 6%

survival rate
S I S II S III S IV

References

Malignant Tumors of the Sinuses Treatment & Management. http://emedicine.medscape.com/article/847189-treatment#a28. October 10, 2013.

Nasal Cavity and Sinus Cancer. http://www.cedars-sinai.edu/Patients/HealthConditions/Nasal-Cavity-and-Sinus-Cancer.aspx. October 10, 2013.

Cancer of Maxillary Sinus/Paranasal Sinuses- Symptoms, Diagnosis, Treatment, Prevention. http://www.medindia.net/patients/patientinfo/maxillary-sinus-cancer-symptomsrisk.htm. October 10, 2013. Applied Oncology 2. Head and Neck Introduction PowerPoint. October 10, 2013.