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Sat 31st Aug 2013
HEAPHY 1 & 2
Session 3 / CR2-2
CASE RACE 2 – RT
13:41 – 13:45
Tony FALLON
CANTERBURY / WESTLAND
ABSTRACT
This case race presents the case of a lymphoma patient who was
scanned/planned and treated for an abdominal lymphoma and during the
treatment, it disappeared and was not visible on imaging.... this set in
motion the process of turning computer screens around, changing
windowing levels and calling multiple staff around to try and see the
volume and then a major discovery was made on a cone beam CT.
Chasing the Tumour Around
Christchurch
Anthony Fallon
Radiation Therapist
Canterbury Regional Cancer and Haematology Service
Patient
• Female, 46 YO
• Original Diag. May 2003 - Stage IV Diffuse
large B cell lymphoma
• January 2013 – 1/52 Hx of adbo swelling and
bowel changes >>> Lt Sided Mesenteric
Abdominal Mass
Quick Recap
In anatomy, the
mesentery is the
double layer of
peritoneum
that
suspends
the
jejunum and ileum
from the posterior
wall
of
the
abdomen.
Wikipedia
January 2013
Initial Treatment
• 3 Cycles up to April
•
•
•
•
•
Rituximab on day 1
Cyclophosphamide days 2‐4 Q12H
Vincristine days 5 and 12 (2 doses)
Doxorubicin day 5
Dexamethasone days 2‐5 and 12‐15
Diagnostic Scan April 13
CT Planning Scan May 13
RT Plan
RT Plan
• Gross Tumour Volume = Visible mass
• Planning Tumour Volume = GTV + 1cm
Margin Isotropically.
• Daily CBCT to localise Mass and Daily
RO Review
CBCT Image Day 1 
RT Treatment
• 30Gy/10 # over 2 weeks.
• Daily Ondensatron – Small amount of
Abdominal Gurgling and Cramps.
• Initially increased in Size but then Good
response
Last Day