R.A. Shourbaji

The Impact of Computed Tomography on Early Glottic Cancer Outcomes

Purpose/Objectives: To evaluate the impact of computed tomography (CT) based simulation (CT sim) and planning on early glottic cancer outcomes and toxicity. Materials/Methods: This is a single-institution retrospective study. Two hundred and fifty three patients with T1-2 glottic cancer underwent radiation therapy (RT) via 2 or 3 dimensional RT with Co60 or linear accelerator (LINAC) from January 1998 to 2010. Group A (203 patients, 80%) and B (50 patients, 20%) underwent 2-dimensional RT (2DRT) and 3 dimensional RT (3DRT), respectively. The median age was 65 years for the whole cohort), 67 years for group-A and 63 years for group-B. Males made up 87% of the population in both groups. T1 were 76 and 84% in groups A and B, respectively. The median dose and fraction size were 63Gy and 2.25Gy, respectively. Results: With a median follow-up of 83, 93, and 30 months for the whole cohort, group A and B respectively, the loco-regional control (LRC) was 97.6%. According to the T classification, rates of LRC for T1 (195) and T2 (58 patients) were 99.5 and 91%, respectively. According to the RT modality, rates of LRC were 99.4 and 100% for T1 while they were 89.8 & 100% for T2 in groups A and B, respectively. Acute dysphagia grades ≤2 and 3 were 94 and 0.5 % for group A and 72 and 0% for group B, respectively. Long term toxicity was negligible in both groups. KaplanMeier Curve showed the 5-year cause-specific survival to be 100%. Chi square and multivariate analysis tests showed a significant relationship between CT simulation (3DRT) and LRC (P b 0.0001). Conclusions: CT-based simulation and planning provided better LRC and less acute side effects compared to 2 DRT.

Management of sarcomatoid salivary duct carcinoma of the submandibular gland duct with coexisting seropositive human immunodeficiency virus.

BACKGROUND Sarcomatoid salivary duct carcinoma of the submandibular gland is extremely rare. This paper highlights the impact of surgery and adjuvant radiation therapy on the outcome of this disease. METHODS A 59-year-old man with human immunodeficiency virus presented with a painless, rapidly growing left neck mass. Biopsy followed by surgical excision of the left submandibular gland revealed sarcomatoid salivary duct carcinoma of the submandibular gland duct with perineural invasion and close margins, for which he underwent adjuvant radiotherapy. Post-operative positron emission tomography and computed tomography revealed no residual or metastatic disease. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 M0 (stage II) tumour. RESULTS The patient tolerated his treatment without serious acute or long-term side effects. There was no evidence of disease on comprehensive examination or on positron emission tomography or computed tomography scans at the 4.6-year follow up. CONCLUSION Surgery followed by adjuvant radiotherapy provided practical locoregional control with acceptable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.

Cranial Nerves Contouring Among Patients Treated With IMRT for Base of Skull, Nasopharyngeal, and Paranasal Sinus Cancer

Purpose/Objectives: To develop a standardized methodology for cranial nerves IX-XII contouring among patients treated with intensitymodulated radiotherapy (IMRT) for head and neck cancer (HNC). Materials/Methods: Using anatomic texts, radiologic data, and T1/2 magnetic resonance imaging (MRI), a standardized method for delineating the cranial nerves IX-XII on computed tomography (CT) was performed. A neuroradiologist assisted with identification of the cranial nerves IX-XII and adjacent structures (i.e. Midbrain, Pons, and Medulla Oblongata). These organs at risk were then contoured on 5 consecutive patients undergoing IMRT for locally advanced HNC (i.e. base of skull, nasopharyngeal and Paranasal-sinus cancer). Dosevolume histogram (DVH) curves were generated by applying the proposed cranial nerves contour to the initial treatment plan. Due to anatomical nature and proximity of cranial nerves IX, X and XI, they were contoured as one structure while cranial nerve XII was contoured individually. Results: The median total dose to the planning target volume (PTV) was 70 (ranged from 66–70 Gy). The median cranial nerves (IX-XI) and (XII) volumes were 20 cm3 (15–25) and 18 cm3 (15–22) respectively. The median V50, V60, V66, and V70 of the cranial nerves (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The maximal dose to the cranial nerves (IX-XI) and (XII) were 72 (66–77) and 71 Gy (64–78) respectively. Conclusions: The proposed methodology provides a highly reproducible, defined and standardized way for delineating the cranial nerves IX-XII organ at risk on IMRT based CT planning. Our dosimetric analysis should serve as pilot data for prospective studies for patients undergoing IMRT for HNC to establish a limiting dose for these structures at risk.