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Hippocampus Sparing
Ryan Kisamore
General Patient Facts
• Female
• Aged: 64
• Metastatic Disease from second battle with Breast CA, current lesions in
multiple sites.
• Treated at V7 with Whole Brain Irradiation
• VMAT with fields that spare the Hippocampus
Past Medical History
•
• Medical History
Social
• Single
• Breast Cancer – 1997 + 2009 • No Children
• Hypothyroidism • No Spouse
• Thyroid Cancer • Menarche at age 14
• Typical presenting signs can vary depending on location and size of lesion
within the brain.
• Patient is pleasant women with minimal symptoms.
• Primary Symptom is recurrent “episodes” of left sided numbness.
• Also reports mild pain in areas of metastasis. She associated this with her
growing age.
• Migraines
Medications
• Dexamethasone
• Letrozole
• Levothyroxine
• Multi-Vitamin
• Was prescribed decadron in July, but claimed the only
• Omega-3 Capsule effect it has had is that it “makes her crazy.”
• Probiotic • After these problems her Primary Physician prescribed
the Sumatriptan which has helped limit symptoms.
• Sumatriptan
• Vitamin D3
• Omeprazole
• Fulvestrant
Breast
Review
• Lies over the Pectoralis
Muscle.
• Attached to the Chest Wall
via Cooper’s Ligament
• Consist mainly of Glandular
and Fatty Tissue
• Filled with several lobes
which contain even smaller
lobules.
• Ducts from the lobes
converge into the nipple.
Breast Lymphatics
• Axilla – 3 Levels • Sentinel Lymph Node Biopsy
• Removing and Testing the first lymph node
• Level-1: Proximal/Low Axilla
that drains from a Tumor
• Level-2: Mid Axilla • Dye or Radioactive Tracers are injected into
• Level-3: Apical Axilla tumor.
• Following the movement of substance, we
• Internal Mammary Chain (IMC) remove the first node of drainage.
• Supraclavicular Nodes
• Intra Mammary Nodes
• Rotter’s Nodes
Breast CA: Incidence and Epidemiology
• Female
• It is possible for men to develop Breast Cancer
• Age
• Family History
• BRCA Mutations
• Past Breast CA History
• Alcohol Consumption
• Minimal Exercise
• Hormone Replacement
• Early Menarche
• Late Menopause
• Late Age of First Child
Types of Breast CA
• Headaches
• Hair loss • This patient has had issues with change in
emotions due to treatments and drugs.
• Nausea
• She expressed a lot of fatigue and soreness
• Vomiting
• Her hair has not thinned more than already thin
• Fatigue before treatment.
• Hearing loss • Less Episodes of Numbness
• Skin and scalp changes • This treatment was used to ensure an increased
Quality of Life without too many major side
• Trouble with memory and speech effects.
• Seizures
Prognosis and Survival Over Five Years
• Griffin, Haley. Breast Introduction. Present at: RADSCI 3574 - Applied Radiation Oncology 2; March 2018; Columbus, Ohio
• Griffin, Haley. Breast CA. Present at: RADSCI 3574 - Applied Radiation Oncology 2; March 2018; Columbus, Ohio
• Griffin, Haley. Breast Treatment. Present at: RADSCI 3574 - Applied Radiation Oncology 2; March 2018; Columbus, Ohio
• Hackworth, Ruth. CNS Adult Tumors. Present at: RADSCI 3573 - Applied Radiation Oncology 1; Fall 2017; Columbus, Ohio
• Gondi V, Tolakanahalli R, Mehta MP, et al. Hippocampal-Sparing Whole Brain Radiotherapy: A “How-To” Technique,
Utilizing Helical Tomotherapy and LINAC-based Intensity Modulated Radiotherapy. International journal of radiation
oncology, biology, physics. 2010;78(4):1244-1252. doi:10.1016/j.ijrobp.2010.01.039.
• Washington, CM & Leaver, D. Principles and Practice of Radiation Therapy. 4th Edition. St. Louis, MO: Elsevier, Inc;
2016:822-836.
Questions?