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Maxillary Sinus Case (T4N0) Squamous-- some questions
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Had a recent case,I'd be interested to have your input for those who'd oblige:
maxillary sinus squamous with perineurial invasion and surrounding and squishing the globe and involving inferior rectus; there was perineurial invasion into foramen rotunda (V2 exit), inferior orbital fissure, and gross involvement of pterygopalatine fossa. Some questions we wrestled with for this case,
1-Cranial nerve coverage-- would you cover individual cranial nerves and track them to base of skull, as is done in the text by Dr. Nancy Lee on IMRT and also cover the CN nerve connections (V2--> VII and V2--V3 in parotid) or just cover the entire skull base? Do you have a reference for how you would draw your volumes besides the previously mentioned text?
2-Perineural Invasion: Does the involvement of the foramina imply perineurial invasion? If the radiology report indicates perineurial invasion on MRI but you cannot see it yourself (bright or thickened track of nerve) what would you do (assume you are unable reach the radiologist) ?
3-Globe Toxicity/Corneal Ulceration: gross disease is squishing the orbit... Will you
Option A) insist that surgery enucleate the currently functioning eye first so that you do not cause pain with 70 Gy to the cornea and associated ulcerations?
Option B) Blast 70 Gy to the orbit if surgery is not on board, and cause severe corneal ulcerations, etc... (a painful enucleation process)
Option C) etc... or would you under dose the gross to protect the patient from pain, with the understanding that surgery will remove any residual disease later?
Option D) something else
==================================
Had a recent case,I'd be interested to have your input for those who'd oblige:
maxillary sinus squamous with perineurial invasion and surrounding and squishing the globe and involving inferior rectus; there was perineurial invasion into foramen rotunda (V2 exit), inferior orbital fissure, and gross involvement of pterygopalatine fossa. Some questions we wrestled with for this case,
1-Cranial nerve coverage-- would you cover individual cranial nerves and track them to base of skull, as is done in the text by Dr. Nancy Lee on IMRT and also cover the CN nerve connections (V2--> VII and V2--V3 in parotid) or just cover the entire skull base? Do you have a reference for how you would draw your volumes besides the previously mentioned text?
2-Perineural Invasion: Does the involvement of the foramina imply perineurial invasion? If the radiology report indicates perineurial invasion on MRI but you cannot see it yourself (bright or thickened track of nerve) what would you do (assume you are unable reach the radiologist) ?
3-Globe Toxicity/Corneal Ulceration: gross disease is squishing the orbit... Will you
Option A) insist that surgery enucleate the currently functioning eye first so that you do not cause pain with 70 Gy to the cornea and associated ulcerations?
Option B) Blast 70 Gy to the orbit if surgery is not on board, and cause severe corneal ulcerations, etc... (a painful enucleation process)
Option C) etc... or would you under dose the gross to protect the patient from pain, with the understanding that surgery will remove any residual disease later?
Option D) something else
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