HEAPHY 1 & 2 CASE RACE 2 – RT Jemma HURLEY Sat 31 st Aug 2013 Session 3 / CR2-4 13:51 – 13:55 CANTERBURY / WESTLAND ABSTRACT This case follows the Radiation Treatment Planning process for a recurrent Glioblastoma Multiforme Brain patient. This patient received two courses of RT to the same site resulting in a total dose of 100Gy to the brain. Interesting points to be covered include patient history, RO prescription choice and associated evidence, planning process and patient implications. This case study will be focused on planning rather than treatment.

Jemma Hurley Radiation Therapist Canterbury District Health Board

Patient Information  58 year old Female  Diagnosis: Glioblastoma Multiforme  Site: Left Brain

Patient History  May 2011: Surgical debulking GBM  June 2011: Commenced Radiation Therapy concurrent w Temozolomide  July 2011: Completed RT  Jan 2012: Completed 6 th cycle Temozolomide  Nov 2012: Recurrent dysphagia & headaches  Dec 2012: Debulking  recurrent GBM commenced PCV chemo  March 2013: MRI  progression  May 2013: Commenced Course 2 Radiation Therapy

Prescription  Course 1: 60Gy/30# to Left Brain  Course 2: 40Gy/20# to Left Brain  Total Dose to Left Brain = 100Gy

Planning Principles

Volumes  Location of tumour made 100Gy possible  Screen dump

Course 1

Course 2

Composite C1/C2

DVHs composite plan

Patient Implications  Brain Necrosis Only significant after 100Gy Brain can recover  Benefit versus Risk  Survival Further 5 months

References  Short SC. Re-irradiation of brain tumours – evidence, indications and limitations. European journal of cancer