CASE DESCRIPTION CASE PHP 2022-01

COURSE title Contouring workshop

COURSE venue and date Available from January 2022 onwards

COURSE director Birgitte Offersen & Philip Poortmans & Orit Kaidar-Person

Contouring administrator Sandra Hol & Orit Kaidar-Person

NUMBER of CASES that will 1

be presented at this course

CASE DESCRIPTION CASE PHP 2022-01

CASE number Mastectomy case

Primary tumour site: Right breast, upper outer quadrant

CASE owner Name Philip Poortmans

Specialty Radiation oncologist
Institute Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium
Email philip.poortmans@gza.be

Imaging modalities CT-only.

TPS used for Dicom export Varian Eclipse

Person(s) in charge of Dicom Name Michaël Claessens

EXPORT3 Specialty Medical physicist
Institute Antwerp University, Wilrijk-Antwerp, Belgium
Email Michael.Claessens@uantwerpen.be

Name Sandra Hol

Person(s) in charge of
Email hol.s@bvi.nl
UPLOADING Dicom-images
into Falcon-EduCase
Symptoms related to tumour Felt herself a lump for some time.
localisation:
Clinical examination: (tumour Palpable induration of about 7 cm in the outer-upper quadrant of the
dimensions, pathological right breast; mobile; no palpable enlarged lymp nodes.
nodes, …if applicable)
Histology: Infiltrating lobular carcinoma, pleiomorphic subtype.

Definitive tumour and Upper outer quadrant of right breast.

pathological node
localisations:
TNM-stage: Stage pT3G3N1aM0; ER = -; PR = -; Her-2-Neu = - (triple negative).

Additional information (endo- Patient of 53 years.

scopy, radiology protocols, Mastectomy: tumour of 7.2 cm; tumour-free margins > 0.7 cm.
….): ALND with only 7 nodes examined, of which 2 had macrometastases
without capsular extension.
Peri-vascular and peri-neural invasion.
MAI = 22; Ki-67: 70%; sTIL's: 5%.
Because of limited axillary dissection with 2/7 nodes involved, combined with the high-risk
and lobular aspects, comprehensive locoregional PMRT was prescribed.

Contouring exercise to be done on the following slices:

• Chest Wall R
• CTV_L1
• CTV_L2
• CTV_L3
• CTV_L4
• CTV_rotter (interpectoral nodes)
• CTV_IM (internal mammary nodes)
• Breast L
• Heart

Remarks:
• SLNB: done, followed by ALND because of positive SLN.
• Contouring: the author contoured all levels, excluding the part that was clearly
removed by the ALND