dr. s. vinodhkumar, mbbs, dmrt dnb pg -radiation …...dr. s. vinodhkumar, mbbs, dmrt dnb pg...
TRANSCRIPT
ESMO Preceptorship Programme
Sinonasal Undifferentiated
Carcinoma (SNUC)
Dr. S. Vinodh kumar, MBBS, DMRT
DNB PG - Radiation Oncology
BIACH&RI, India
Head and Neck - Hong Kong - 13 th & 14th April 2019
ESMO PRECEPTORSHIP PROGRAMME
� No disclosure
ESMO PRECEPTORSHIP PROGRAMME
� She consulted an ENT specialist
� Case historyCase historyCase historyCase history ::::� 28 year old female
� No comorbids & habits
� No family history
� Not on regular medications
� ECOG PS-1
� SymptomsSymptomsSymptomsSymptoms : Sep 18: Sep 18: Sep 18: Sep 18
� Right nasal obstruction
� 2-3 episodes of right nasal bleed
� Anosmia
� Swelling of right side of face
� Headache
ESMO PRECEPTORSHIP PROGRAMME
� Right nasal mass biopsy : AngiomatousAngiomatousAngiomatousAngiomatous polyppolyppolyppolyp
� CECT PNSCECT PNSCECT PNSCECT PNS : : : : � Isodense mass lesion in right nasal
cavity , right maxillary , frontal , B/L ethmoidal and right half of sphenoid sinus
� Destruction of right turbinates, cristagalli, B/L cribriform plate, right medial wall of orbit and walls of frontal and ethmoid sinus and anterior cranial fossa
� Impression : Inverted Inverted Inverted Inverted papillomapapillomapapillomapapilloma/SCC/SCC/SCC/SCC
ESMO PRECEPTORSHIP PROGRAMME
� Nov 2018Nov 2018Nov 2018Nov 2018 : : : : Referred to our centre for further management
� Oct 2018Oct 2018Oct 2018Oct 2018 :::: Underwent endoscopic excision of the mass by ENT surgeon
� PostopPostopPostopPostop HPEHPEHPEHPE : High grade malignant tumor -undifferentiated carcinoma
� to rule outneuroendocrine/ nasopharyngeal carcinoma
SinonasalSinonasalSinonasalSinonasal undifferentiated Caundifferentiated Caundifferentiated Caundifferentiated Ca
S100 focal
weak +
PancytoPancytoPancytoPancyto
keratin+, keratin+, keratin+, keratin+,
CK 7 & 19 CK 7 & 19 CK 7 & 19 CK 7 & 19 focal+focal+focal+focal+
Synaptophysin-
ESMO PRECEPTORSHIP PROGRAMME
L/E
• No neck nodes palpable
Blood investigations
• Normal limits
CXR
• B/L lungs clear
• NAD
US A&P
• Liver normal
• NAD
CECT
• Soft tissue dense thickening in right nasal cavity extending into right maxillary, ethmoid, frontal and sphenoid sinuses.
• Closely abutting lamina papyracea with ?erosion of cribriform plate - ?residue/ ?recurrence.
• Multiple small volume B/L level IB, II, III nodes -non specific.
ESMO PRECEPTORSHIP PROGRAMME
� Nov 2018Nov 2018Nov 2018Nov 2018 : : : : Planned for adjuvant chemoradiationusing IMRT technique
� Jan Jan Jan Jan 2019201920192019 :::: She completed her treatment, a total dose of 66Gy in 33# along with 6 cycles of weekly cisplatin without any treatment breaks. Developed grade II mucositis and CINV.
TD 66Gy to H&N
TD 66Gy to H&N
Phase I 50Gy : PTV50
Phase I 50Gy : PTV50
weekly CDDP
40mg/m
weekly CDDP
40mg/m2
Phase II 66Gy : PTV66
Phase II 66Gy : PTV66
ESMO PRECEPTORSHIP PROGRAMME
� Optimal sequence of treatment modalities - Sx followed by
CRT/ CRT followed by Sx/ ICT followed by Sx or RT ?
� Role of Induction chemotherapy(ICT) - preferred regimen ?
� Role of Cetuximab - induction, concurrent & adjuvant ?
� Role of PETCT in diagnosis and assessment of treatment
response in SNUC ?
ESMO Preceptorship Programme
Thank you for your attention