3 CASES - LOW DOSE CRANIOSPINAL IRRADIATION (CSI) FOR ADULT GERMINOMA - RADIATION FOR GRAVES DISEASE - RADIATION FOR MEDIASTINAL GRAY ZONE LYMPHOMA (MGZL)

1. Guiding your journey through cancer care Dr. Vimoj J. Nair
RADIATION ONCOLOGY
CASE ROUNDS
Dr. Vimoj J. Nair
Dept. of radiation oncology
Prince Edward island cancer treatment Centre,
Charlottetown

2. Guiding your journey through cancer care Dr. Vimoj J. Nair
OBJECTIVE
• 3 cases
• Adult Germinoma
• Graves Orbitopathy
• Mediastinal Gray Zone Lymphoma

3. Guiding your journey through cancer care Dr. Vimoj J. Nair
RADIATION TRIVIA
Numéro 1

4. Guiding your journey through cancer care Dr. Vimoj J. Nair
WHAT’S SPECIAL ABOUT THIS
WEEK?
• held annually in the week that contains
November 8,
• the anniversary of the founding of the x-
ray by Wilhelm Roentgen in 1895
• The Essential Link: Where advanced
Technology Meets Compassionate
Care.

5. Guiding your journey through cancer care Dr. Vimoj J. Nair
ANY THING ELSE SPECIAL
ABOUT THIS WEEK?
• November 7
• IDMP 2014: Recognizing the Great Contribution of Medical
Physics to Medical Imaging Progress
• 1867, Marie Curie, known for her pioneering research on
radioactivity, was born in Poland.

6. Guiding your journey through cancer care Dr. Vimoj J. Nair
ANY THING ELSE SPECIAL
ABOUT THIS WEEK?
• National Radiation Protection Professionals Week
• week of 2–8 November 2014

7. Guiding your journey through cancer care Dr. Vimoj J. Nair
NEXT WEEK IS SPECIAL TOO!!

8. Guiding your journey through cancer care Dr. Vimoj J. Nair
CASE 1
Adult Supratentorial germinoma

9. Guiding your journey through cancer care Dr. Vimoj J. Nair

10. Guiding your journey through cancer care Dr. Vimoj J. Nair
VMAT BASED LOW DOSE
CSI (CRANIOSPINAL
IRRADIATION)
• 25 Gy in 20 Fractions to Brain and spine
• 40 Gy in 20 – Tumor boost

11. Guiding your journey through cancer care Dr. Vimoj J. Nair
MRI BEFORE CSI POST TREATMENT
MRI

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MRI BEFORE CSI POST TREATMENT
MRI

13. Guiding your journey through cancer care Dr. Vimoj J. Nair
SIDE EFFECTS

14. Guiding your journey through cancer care Dr. Vimoj J. Nair
TRIVIA
QUESTION NO 2

15. Guiding your journey through cancer care Dr. Vimoj J. Nair
WHOSE’S RING
IS THIS?
A. Madame Curie
B. Pierre Curie
C. Mrs. Roentgen
D. Mrs. Varian
E. Mr. Cobalt

16. Guiding your journey through cancer care Dr. Vimoj J. Nair
CASE2
GRAVES ORBITOPATHY

17. Guiding your journey through cancer care Dr. Vimoj J. Nair
GRAVES ORBITOPATHY

18. Guiding your journey through cancer care Dr. Vimoj J. Nair
GRAVES
ORBITOPATHY/OPTHALMOPATHY/
THYROID EYE DISEASE
• 50% of patients with Graves disease
• Radiation therapy is done for disease refractory to
surgery/steroids
• Response
50-90% response rates

19. Guiding your journey through cancer care Dr. Vimoj J. Nair

20. Guiding your journey through cancer care Dr. Vimoj J. Nair

21. Guiding your journey through cancer care Dr. Vimoj J. Nair
TRIVIA
QUESTION NO 2

22. Guiding your journey through cancer care Dr. Vimoj J. Nair
WHICH ACTIVITY EXPOSES YOU TO
THE HIGHEST AMOUNT OF
RADIATION?
A. Smoking a pack of cigarettes a day
B. Gaming on an XBOX 360 with Kinect!
C. basic chest X-ray
D. Sipping on a medium sized coffee from Tim Horton’s daily

23. Guiding your journey through cancer care Dr. Vimoj J. Nair
ANSWER
• Cigarettes contain polonium-210 and lead
• estimated that smoking a pack-and-a-half every day exposes a
smoker to a dose of radiation equivalent to 300 chest X-rays a
year
• Polonium is an alpha emitter. Poor penetration.
• * 1kg coffee = 1000 bequerel
* Royal Society of Chemistry, Radiochemical Methods
Group

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25. Guiding your journey through cancer care Dr. Vimoj J. Nair
CASE 3
MEDIASTINAL GRAY ZONE LYMPHOMA

26. Guiding your journey through cancer care Dr. Vimoj J. Nair
MEDIASTINAL GRAY ZONE
LYMPHOMA (MGZL)
• Type of lymphoma that is characterized by having
cellular features of both
• Primary mediastinal large b-cell lymphoma (PMBL)
• And classic hodgkin lymphoma of the nodular sclerosis
type (CHL-NS)

27. Guiding your journey through cancer care Dr. Vimoj J. Nair
CASE HISTORY
• 34 year old
• Diagnosed 4 years ago
• Post chemo, post transplant
• Residual disease

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2011 2012

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2013 2014

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32. Guiding your journey through cancer care Dr. Vimoj J. Nair
ISRT

33. Guiding your journey through cancer care Dr. Vimoj J. Nair
THANK YOU FOR YOUR PATIENCE!

34. Guiding your journey through cancer care Dr. Vimoj J. Nair