Palliative Worksheet

Site: L4 & LT HIP

Patient Info:
Age: 68 Gender: M
Diagnosis: metastatic prostate cancer

Medical history/comorbidities:
 Prostatectomy 2015 for Gleason 4+4 adenocarcinoma
 Pt had a rising PSA level since 2017 which reached 20.1 ng/mL- commenced Zoladex which
had a positive effect reducing his PSA to 13.3
 Father died of prostate cancer (possible familial link)

Prescription: 20Gy/ 5 fx, 4Gy/# over I week

Intent: Palliative with the intent of relieving his pain
Other treatments for this diagnosis (concurrent or adjuvant?):
Hormone therapy – Zoladex = GnRH agonist

Psychosocial:
1. Recently retired – financial problems since relying on single income assuming the
wife is still working.
MDT -Those undergoing radiotherapy need specialist input from experienced radiographers, nurses
and physiotherapists to help them to rehabilitate and regain neurological function

CT:
Positioning/Immobilisation:
How would this pt be set-up in your department?
1. HFS
2. Mattress
3. NRF
4. LR(not indexed)

CT preparation required:
Is there anything this pt needs to do to prepare for CT in your department?
Pain medication could be taken before CT

Scan Levels:
What anatomy needs to be included in the scan and why?

Do any markers/wires or bolus or packing need to be placed for CT?:

Angiocaths

Department of Radiation Therapy, University of Otago Wellington 2019

Planning:
Volumes:
List the volumes present, what is included in each (including margin size) and whether the
margin seems appropriate.
VOI = volume of interest
For the PTV note the size, shape and location
1. LEFT HIP – VOI is large, circular and located in pelvis region with a margin size of 1 cm
2. L4 VERTEBRAE – VOI is medium size, circular located deep in the abdomen pelvic region

OAR:
List the OAR present and their tolerance doses (use departmental tolerance doses where
applicable). Indicate which structures will need to be contoured.
1. L4 vertebrae – Spinal cord & small bowel
2. Left Hip – Small bowel + bladder + rectum

Inhomogeneities:
List inhomogeneities present and their RED’s. Indicate if any density overrides are required.
Soft tissue
Bone
Gas (small bowel)

Proposed Beam Arrangement:

Consider size, shape and location of PTV as well as surrounding OAR - draw a diagram below
Parallel Opposed Pair for both Plans

Energy:
Considering depth to the PTV and entry and exit dose to OAR, indicate which energies you
think you will use for each beam
1. L4 Plan = 18MV for both tmt field
2. PELVIC = 6MV for ANT beam & 18MV for POST beam

Department of Radiation Therapy, University of Otago Wellington 2019

Weightings:
Considering depth to the PTV and entry and exit dose to OAR, list your beams below in
order of expected weighting, highest to lowest
1. Posterior will be highly weighted because the distance from skin to vertebral bodies will be
small

Wedges:
List the beams which will require wedges, note the orientation and estimate the size (this
may just be “large” or “small”)
At this stage = No

Treatment:
Isocentre position:
What information will you need to give treatment so that they can locate the planned
treatment isocentre? Think about the process you have seen in your department on day 1 of
treatment.

Imaging:
What kind of imaging would this patient receive whilst on treatment if they were to be
treated in your department? How frequent would this imaging be? What structures would
be matched to?
 Daily KV Imaging – bony match = for bony matches

Treatment preparation:
Is there anything this pt needs to do to prepare for treatment in your department?
Daily antiemetics – case to case basis because some people find that they don’t need antiemetics

Department of Radiation Therapy, University of Otago Wellington 2019

Clinical Acceptability:
On completion on your plan state whether or not you think it is a clinically acceptable plan
and why. You will need to consider:
 Dose distribution
o ICRU dose variation (dose coverage and CSM)
o Dose homogeneity
o Dose conformity (including hotspots)
 Dose to OAR
o Acute reactions that will occur _ faint reddening of skin
o Endpoint reactions that will occur_ None at this point

Department of Radiation Therapy, University of Otago Wellington 2019