TUMOR BOARD

21 Sep 2022
 Patient information
•Name: N.H.D Male
•DOB: 24 Jan 2015
•Date of admission: 25 July 2022
•Chief complaint: lymphadenopathy

05/09/2023 2
Medical History
• He presented with billateral neck lymph nodes enlargement for 1 month.
• In June 2022: the left neck lymph node biopsy  Pathology: suspected
metastasis carcinoma.
• ENT Endoscopy: Nasopharyngeal tumor was 1.5cm in size
Biopsy: non-keratinizing squamous cell carcinoma , undifferentiated type
Immunochemistry: AE1/AE3 (+), P63+, EBER +
• Diagnosis: Nasopharyngeal Carcinoma T3 N3 M0 / EBV DNA (+)
• Chemotherapy Treatment: Cisplatin + 5 FU x 03 cycles.
 Treament Process
15 July Cycle 1: Cisplatin + 5 FU
Full dose 100%.
04 Aug Cycle 2: Cisplatin + 5 FU
25 Aug Cycle 3: Cisplatin + 5 FU
05 Sep  Evaluation
19 Sep Preparing for radiation therapy
MRI: T1 (June/2022-before treatment)
MRI: T2 (June/2022-before treatment)
MRI: T1 (Sep/2022- after 3cycles of
chemotherapy)
MRI: T2 (Sep/2022- after 3cycles of
chemotherapy)
MRI: Before and after 3 cycles
Partial Response
PET-CT (Sep-2022) – after 3 cycles
• Imaging shows the tumor involvement in the right naso-pharyngeal
cavity, with infiltration of the posterior nostril, size: 23x19x15 mm;
with increased FDG uptake (SUVmax: 4.3)
• Bilateral II, III, IV, Va neck lymph nodes, the largest sized 10mm-short
axis, with increased FDG uptake (SUVmax: 3.7)
Summary
• 7 years old boy

• Diagnosis: Nasopharyngeal Carcinoma T3 N3 M0 / EBV DNA (+)

• Chemotherapy Treatment: Cisplatin + 5 FU x 03 cycles.
• Re-evaluation : PR (50-80%)
Protocol
Green: CTV1
(Pre
chemotherapy +
high risk region)
Red: PTV2
(54Gy)
Green: GTV2
(Post chemotherapy)
Purple: CTV2
Yellow: PTV2 (59.4Gy)
Question?
• What is optional imaging to evaluate the response of induction
chemotherapy? PET/CT or MRI-contrast or CT-contrast?
• Regarding RT, should we aprrove this protocol for all NPC under 18yo?
(Some study showed that curable dose for head ans neck SCC was 65-
70Gy, so we are really concerned about the risk of regional recurrent
due to reduce the dose of RT)
• In children, Is dose acceptable in OARs different from adults?
• Should we use Cisplatin 1 day every week or 3 day every 21 days?