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P195. Alpha-cradle with four-point fixation thermoplastic mask system: An improvement of repositioning accuracy in head and neck radiotherapy
Abstracts / Oral Oncology 47 (2011) S74–S156
Case: An 87-year-old woman was referred to oral surgery, with a swelling on the right side of the cheek. Present history revealed that the swelling was gradually growing over a period of 1 month and was not associated with pain, tenderness or discharge. The patient stated that the swelling was becoming larger ever since. The patient experienced more swelling when she tilted her head down. The skin over the diffuse swelling appeared normal. Intraoral examination revealed a mass, extending from buccal vestibule to the edentulous alveor process of the corresponding to maxillary right premolars. The mass was smooth surface, soft in consistency, painless and no pulsation on palpation, and measured about 3 3 cm. There was no pulsation. Examination of the cervical lymph nodes was unremarkable with no evidence of lymphadenopathy. Radiographic views showed radiopacity in the right maxillary sinus and nasal cavity as well as the absence of a right maxillarytuberosity line. A CT scan showed an illdefined mass with nonhomogeneous and increased density occupying the right maxillary sinus extending to the pterygopalatine fossa. Destruction of the posterior maxillary sinus wall with invasion of the ethomoidal sinus was observed.Since the tumor had started to grow rapidly in 1 month and spontaneous bleeding was fond, a malignant tumor was strongly suspected, but it was different from a squamous cell carcinoma. The result of biopsy was angiosarcoma. Postoperative radiotherapy using cyberknife after cytoreductive surgery was carried out. An aggressive growth was well controlled and a good response was noted 10 months after radiotherapy. Conclusion: Angiosarcoma is an extremely rare neoplasm of maxillary sinus. We report a case of angiosarcoma of the maxillary sinus together with the treatment of cytoreductive surgery and radiotherapy using cyberknife. Radiotherapy using cyberknife is an effective treatment for angiosarcoma of maxillary sinus. doi:10.1016/j.oraloncology.2011.06.437
P195. Alpha-cradle with four-point fixation thermoplastic mask system: An improvement of repositioning accuracy in head and neck radiotherapy P.P. Pang*, A. Chua, Y.L. Soong, S.L. Cheah, T.S. Wee, K.W. Fong National Cancer Centre, Department of Radiation Oncology, Singapore Introduction: Aim to innovate the current mask system by incorporating the alpha-cradle into four-point Klarity thermoplastic mask. Methods: This study group consists of 46 head and neck patients scheduled for Intensity modulated radiation therapy (IMRT). The group consists of all disease stages. The typical treatment prescription for these patients is 60–66 Gy delivered over 30–33 fractions in approximately 6–6.5 weeks. To measure the reproducibility and day-to-day treatment set-up consistency, the deviation of the treatment target centre will be quantified. Two areas of geometric verifications to be measured are systematic set-up error (SSE) and random set-up error (RSE). The patients’ positions are acquired at the first three fractions of the treatment and fusion was done online through the image fusion tools available on MOSAIQ. After the first three fractions of the treatment, average SSE was calculated offline as per departmental imaging protocol. Van Herk’s margin recipe is used to calculate the minimum planning margins required based on the magnitude of the SSE and RSE. Retrospective reviews will be carried out on the rate of reshell due to loss of weight and eventually lack of neck and shoulder support. Results: Improvements can be observed from the retrospective reviews on the CT images and frequency of reshell. Although SSE has drawn slight improvement (p = 0.476–0.862) for the three cardi-
S137
nal planes, however, transverse CT images have firmly illustrated the improvement of alpha-cradle support on the neck and shoulders. In addition, reshell rate over past six months have reduced significantly from 24.8% to 8.7% (p = 0.009) for three-point mask and alpha-cradle with four-point mask, respectively. Discussion: The present study is a focus to evaluate the reliability of the immobilization gadgets used to improve set-up accuracy. One hundred percent of translational displacements were within 5 mm, with 95% within 3 mm. The planning margins were 3 mm in all three directions. In all, alpha-cradle with four-point mask have demonstrated as a form of improvement in head and neck immobilization. doi:10.1016/j.oraloncology.2011.06.438
Reconstruction P196. Microsurgical autotransplantation as a component of rehabilitation of patients with tumors involving oral cavity I. Reshetov *,a, V. Chissov a, A. Sdvizhkov b, S. Kravtzov a, A. Polyakov a, O. Matorin a a b
P.A. Hertzen Moscow Cancer Research Institute, Russia Moscow Municipal Clinical Oncological Dispensary #1, Russia
Objectives: Expansion of surgical treatment radicalism and improvement of patients’ functional and social rehabilitation, using the resources of microsurgical tissue autotransplantation method. Material and methods: Surgical treatment of malignant tumors in maxillofacial zone was conducted for 272 patients. The fourth stage of tumorous process was in 60% of cases in primary tumors group. Scull base and pachymeninx resection was made in 37 (14%) cases. For eliminating of 175 (65%) orofacial defects, 37 (14%) craniofacial defects, 54 (19%) oroorbitofacial, 5 (2%) isolated defects of lower jaw and for functional rehabilitation, autotransplantation of 300 spare flaps was conducted: visceral – 102; skin–muscular–bone (radial, iliac, scapular, fibular, rib-muscular, rib-scapular) – 141, 30 different skin-muscular flaps and 25 skin–fascia radial flaps. Visceral flaps were used for elimination of defects of oral cavity floor, oropharynx, skin–muscular–bone autoflaps for combined defects of facial skeleton and soft tissue. Results: Complications appeared in 67 (25%) cases. Total flap necrosis was registered in 4.7%. Natural nutrition and breathing was restored for 88.6% patients. 93.2% of patients were satisfied with the cosmetic results, 32% returned to their job. Conclusions: Microsurgical reconstruction – a method of effective rehabilitation of patients with a head and neck cancer.
doi:10.1016/j.oraloncology.2011.06.439
P197. Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps W.-L. Chen*, J.-S. Li, D.-M. Zhang Sun Yet-sen Memorial Hospital of Sun Yat-sen University, China Background: Extensive full cheek defects may not be amenable to reconstruction with a single flap. In this study, we evaluated the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island
Case: An 87-year-old woman was referred to oral surgery, with a swelling on the right side of the cheek. Present history revealed that the swelling was gradually growing over a period of 1 month and was not associated with pain, tenderness or discharge. The patient stated that the swelling was becoming larger ever since. The patient experienced more swelling when she tilted her head down. The skin over the diffuse swelling appeared normal. Intraoral examination revealed a mass, extending from buccal vestibule to the edentulous alveor process of the corresponding to maxillary right premolars. The mass was smooth surface, soft in consistency, painless and no pulsation on palpation, and measured about 3 3 cm. There was no pulsation. Examination of the cervical lymph nodes was unremarkable with no evidence of lymphadenopathy. Radiographic views showed radiopacity in the right maxillary sinus and nasal cavity as well as the absence of a right maxillarytuberosity line. A CT scan showed an illdefined mass with nonhomogeneous and increased density occupying the right maxillary sinus extending to the pterygopalatine fossa. Destruction of the posterior maxillary sinus wall with invasion of the ethomoidal sinus was observed.Since the tumor had started to grow rapidly in 1 month and spontaneous bleeding was fond, a malignant tumor was strongly suspected, but it was different from a squamous cell carcinoma. The result of biopsy was angiosarcoma. Postoperative radiotherapy using cyberknife after cytoreductive surgery was carried out. An aggressive growth was well controlled and a good response was noted 10 months after radiotherapy. Conclusion: Angiosarcoma is an extremely rare neoplasm of maxillary sinus. We report a case of angiosarcoma of the maxillary sinus together with the treatment of cytoreductive surgery and radiotherapy using cyberknife. Radiotherapy using cyberknife is an effective treatment for angiosarcoma of maxillary sinus. doi:10.1016/j.oraloncology.2011.06.437
P195. Alpha-cradle with four-point fixation thermoplastic mask system: An improvement of repositioning accuracy in head and neck radiotherapy P.P. Pang*, A. Chua, Y.L. Soong, S.L. Cheah, T.S. Wee, K.W. Fong National Cancer Centre, Department of Radiation Oncology, Singapore Introduction: Aim to innovate the current mask system by incorporating the alpha-cradle into four-point Klarity thermoplastic mask. Methods: This study group consists of 46 head and neck patients scheduled for Intensity modulated radiation therapy (IMRT). The group consists of all disease stages. The typical treatment prescription for these patients is 60–66 Gy delivered over 30–33 fractions in approximately 6–6.5 weeks. To measure the reproducibility and day-to-day treatment set-up consistency, the deviation of the treatment target centre will be quantified. Two areas of geometric verifications to be measured are systematic set-up error (SSE) and random set-up error (RSE). The patients’ positions are acquired at the first three fractions of the treatment and fusion was done online through the image fusion tools available on MOSAIQ. After the first three fractions of the treatment, average SSE was calculated offline as per departmental imaging protocol. Van Herk’s margin recipe is used to calculate the minimum planning margins required based on the magnitude of the SSE and RSE. Retrospective reviews will be carried out on the rate of reshell due to loss of weight and eventually lack of neck and shoulder support. Results: Improvements can be observed from the retrospective reviews on the CT images and frequency of reshell. Although SSE has drawn slight improvement (p = 0.476–0.862) for the three cardi-
S137
nal planes, however, transverse CT images have firmly illustrated the improvement of alpha-cradle support on the neck and shoulders. In addition, reshell rate over past six months have reduced significantly from 24.8% to 8.7% (p = 0.009) for three-point mask and alpha-cradle with four-point mask, respectively. Discussion: The present study is a focus to evaluate the reliability of the immobilization gadgets used to improve set-up accuracy. One hundred percent of translational displacements were within 5 mm, with 95% within 3 mm. The planning margins were 3 mm in all three directions. In all, alpha-cradle with four-point mask have demonstrated as a form of improvement in head and neck immobilization. doi:10.1016/j.oraloncology.2011.06.438
Reconstruction P196. Microsurgical autotransplantation as a component of rehabilitation of patients with tumors involving oral cavity I. Reshetov *,a, V. Chissov a, A. Sdvizhkov b, S. Kravtzov a, A. Polyakov a, O. Matorin a a b
P.A. Hertzen Moscow Cancer Research Institute, Russia Moscow Municipal Clinical Oncological Dispensary #1, Russia
Objectives: Expansion of surgical treatment radicalism and improvement of patients’ functional and social rehabilitation, using the resources of microsurgical tissue autotransplantation method. Material and methods: Surgical treatment of malignant tumors in maxillofacial zone was conducted for 272 patients. The fourth stage of tumorous process was in 60% of cases in primary tumors group. Scull base and pachymeninx resection was made in 37 (14%) cases. For eliminating of 175 (65%) orofacial defects, 37 (14%) craniofacial defects, 54 (19%) oroorbitofacial, 5 (2%) isolated defects of lower jaw and for functional rehabilitation, autotransplantation of 300 spare flaps was conducted: visceral – 102; skin–muscular–bone (radial, iliac, scapular, fibular, rib-muscular, rib-scapular) – 141, 30 different skin-muscular flaps and 25 skin–fascia radial flaps. Visceral flaps were used for elimination of defects of oral cavity floor, oropharynx, skin–muscular–bone autoflaps for combined defects of facial skeleton and soft tissue. Results: Complications appeared in 67 (25%) cases. Total flap necrosis was registered in 4.7%. Natural nutrition and breathing was restored for 88.6% patients. 93.2% of patients were satisfied with the cosmetic results, 32% returned to their job. Conclusions: Microsurgical reconstruction – a method of effective rehabilitation of patients with a head and neck cancer.
doi:10.1016/j.oraloncology.2011.06.439
P197. Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps W.-L. Chen*, J.-S. Li, D.-M. Zhang Sun Yet-sen Memorial Hospital of Sun Yat-sen University, China Background: Extensive full cheek defects may not be amenable to reconstruction with a single flap. In this study, we evaluated the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island