CASE STUDY
*The student will need to complete two (2) case studies worth 100 points each. (1 page per case study (2) pages)
*Each case study will need to be presented in the format below. (see Case Study Example)
Case Study Example
History and Physical
57 year old male diabetic
Blood pressure 157/92, pulse 96, temp 97.0, oxygen sat 97, resp. rate 20
Pt has had weight problems and was advised to lose some weight. He dropped his weight from 240 lbs. to 180 lbs. It was at this time that the patient started having GI complaints. He has been able to keep food down as of recent. No known drug allergies. Currently taking Lantus and NovoLog insulin in addition to pancreas. Occasionally will take oxycodone for post op pain.
Detection
Developed obstructive jaundice which was diagnosed on a CT exam. Patient had stents placed where biopsies showed atypical cells. His tumor marker CA 19.9 was elevated to 822. Patient underwent a Whipple procedure and there was no evidence of metastatic disease. Histological findings at the time of the procedure revealed an adenocarcinoma of the pancreatic head.
Treatment
Adjuvant treatment will be used given chemotherapy and external beam radiation.
Chemo used= 5FU
Radiation therapy will consist of IMRT treatment (tx) to the pancreas area
Simulation
Patient (pt) was simulated in the supine position. Wing board with head rest and arms up above head. Knee-sponge and toes together for comfort. A vac- loc bag was made and placed under the pts pelvis and lower abdomen area for stabilization. Pt was given 3 anterior tattoos and 2 lateral tattoos for set up purposes. Taken to CT and set up in the same position as simulation, CT markers were placed on the tattoos and a CT scan was done using 3mm slices.
Radiation treatment and planning
Treatment is to be done with IMRT. CT scan was downloaded and critical structures were contoured (spine, lt/rt kidney, liver, small bowel, lymph nodes, and a CTV) IMRT plan involved the use of 8 non coplanar beams. A 1.5cm PTV was created from the CTV and lymph nodes. Constraints were placed and used for the IMRT plan for the kidneys, liver, spine and PTV. Pt is to be treated to 4500cGy/ 180cGy/fx for the initial tx with a boost tx to be created later to for an additional dose of 900cGy giving a total dose for the complete course of 5400cGy.
Pancreatic cancer
Accounts for 2% of all cancers
4th leading cause of cancer deaths
Rarely occurs under age of 40
No known cause (smokers have a 2-3 increase risk factor)
Majority of malignancies are adenocarcinomas (80%)
Spread of the disease is usually locally invasive into the small bowel, stomach and colon