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ROSE CASE
MOULD BRACHY UVULA
RADIATION ONCOLOGY
SIMULATION TO EXECUTION
DR KANHU CHARAN PATRO
HISTORY
• Painful swallowing
• Mass in the upper part of palate
DIAGNOSIS BY LOCAL ENT SURGEON
• 1.5 x 1.5 cm uvular growth
• Not extending to soft palate
• Planned biopsy
EXICISIONAL BIOPSY
• Outside by ENT surgeon
BIOPSY REPORT
• PT-1X0.8X0.8 CM
• Squmaous cell carcinoma
• Moderately differentiated
• Margins not commented
NECK NODE EVALUATION
• NON SPECIFIC LYMPHADENOPATHY
– MRI
– USG
– CT
FINAL DIAGNOSIS
• CANCER UVULA –POST EXICIONAL BIOPSY
• MARGIN NOT COMENTED
• pT1NOMO
TUMOR BOARD PLAN
• BRACHYTHERAPY
• MOULD
• EQD2- 60Gy
REQUIREMENTS
FOR MOULD PREPARATION
• ALGINATE IMPRESSION MATERIAL
• Cast
• Dental stone
• Water
• U-CLASP
• COLD CURE ACRYLIC powder and
liquid
• 2ml syringe
• Spatula
FOR BRACHY
• Gention violet
• Ear bud
• 2ml syringe
• Spatula
• Miro pore
• Copper wire
• Quickfix
• Xylocaine spray
MOULD PREPARATION
SELECTION OF IMPRESSION TRAY
MIXING ALGINATE IMPRESSION MATERIAL
UPPER IMPRESSION TAKEN WITH
ALGINATE IMPRESSION MATERIAL
MIXING DENTAL STONE WITH WATER
POURING OF CAST WITH DENTAL STONE
DENTAL CAST
PREPARATION OF U-CLASP WITH SS WIRE
PREPARATION OF U-CLASP WITH SS WIRE
POURING OF CAST WITH DENTAL STONE
U-CLASP
DENTAL CAST WITH FOUR U-CLASPS
APPLICATION OF SEPARATING MEDIUM
DENTAL CAST, COLD CURE ACRYLIC POWDER AND LIQUID
SPRINKLE TECHNIQUE
SPRINKLE TECHNIQUE
SPRINKLE TECHNIQUE
REMOVAL OF PROSTHESIS FROM DENTAL CAST
AFTER TRIMMING OF SHARP MARGINS
CHECKING THE FIT OF PROSTHESIS IN PATIENTS MOUTH
ADDITION OF MODELLING WAX TO PROSTHESIS
IOP in patients mouth
IOP IN PATIENTS MOUTH
Intra oral Prosthesis
INTRA ORAL PROSTHESIS
SPACING OF WIRES
GROOVING
FIXING WITH QUICK FIX
GENTION VIOLET
EAR BUD
EAR BUD –CUT ONE SIDE
2ML SYRINGE
FILL THE EAR BUD
MARK THE TARGET AREA
TAKING IMPRESSION AND
EXTRAPOLATION ON MOULD
COPPER WIRE
FXING THE COPPER WIRE
FINAL MOULD
CONTACTING WITH PPW
SEPARATING THE PPW BY RYLE’S TUBE
PLANNING CT
• 1 MM SLICE
• SUPINE
• WITH MOULD
• WITH IOP
• VERTEX TO CLAVICLE
• MULTIPLANNAR
CATHETER NUMBERING
CATHETER RECONSTRUCTION
TARGET DELINEATION
• Target definition of the Gross Tumor Volume (GTV)
and Clinical Target Volume (CTV) are usually
performed by clinical examination aided by imaging
and intraoperative findings.
• In brachytherapy, typically no additional margin is
required to ensure that theCTV receives the planned
dose and therefore.
• Unlike external beam irradiation, CTV and PTV
(Planning Target Volume) are considered equivalent
DOSE SELECTION
DOSE SELECTION
• 4GY
• TWICE DAILY
• 13/14 FRACTIONS
• ALPHA/BETA-10
TREATMENT GAP
PLANNING
• ACCURATELY MEASURED CATHTER LENGTH BEFORE CT
• CATHTER NUMBERING AND MARKED
• CATHTER RECONSTRUCTION
• PLANNED BY IPSA
• OPTIMIZED GRAPHICALLY
• TREATMENT CALCULATION
• VERIFICATION
• EXECUTION
TARGET DOSE EVALUATION
TARGET DOSE EVALUATION
TARGET DOSE EVALUATION
• CTV coverage is adequate (i.e., D90 is at least 90% of
the prescribed dose)
• The prescription dose is usually the minimum dose
received by the CTV or a CTV surrogate (i.e., the D90 >
100, V100 > 90%)
• DNR should be equal or lower than 0.36 and in IMBT
(intensity modulated Brachytherapy) 0.42
• Dose non-uniformity ratio (DNR= V100/V150)
• The optimal spacing between applicators is <15 mm
TARGET DOSE EVALUATION
COVERAGE INDEX
 CTV VOLUME 0.32CC DESIRABLE
 DNR INDEX V150 / V100 = 34.04/96.42 =0.35 0.36 T0 0.5
 D90
98.34% >90%-100%
 V100
96.42% >90%
 V150
34.04% ALARA
 V200
8.94% ALARA
 V300
2.67% ALARA
ISODOSE IN ALL PLANES
BLUE 85%
RED 100%
ORANGE 150%
WHITE 200%
GREEN 300%
DVH STATISTICS
DRR
OAR EVALUATION
SEPARATING THE BOT
SEPARATING THE BOT
SEPARATING THE BOT
XYLOCAINE SPRAY
IOP- SPACER
TREATMENT POSITIONING
INTRATREATMRNT CARE
• ORAL HYGIENE
• SOS ANALGESICS
POST TREATMENT CARE
• ORAL HYGIENE
• SOS ANALGESICS
• COUNSEL ABOUT THE UPCOMING REACTIONS
FOLLOW UP
1. FOLLOW UP AFTER 3 MONTHS
2. LOCAL EXAMINATION
3. USG NECK FOR NODES
REVIEW LITERATURE
• LIP
• HARD PALATE
• SOFT PALATE
• GINGIVA
HARD PALATE
LIP AND BUCCAL MUCOSA
ALL SITES
UVULA
• NOT REPORTED YET
SUMMARY
• Follow GEC-ESTRO guidelines
• Train your dentist
• Follow steps
• Wires should not touch necked to any surface
• Use lead /IOP
• Reactions usually observed after treatment- do not
get panic , wait
• Counsel
ACKNOWLEDGEMENT
DR RAMAYA REDDY –BDS
1. DR P S BHATTACHARYYA
2. DR C R KUNDU
3. DR V K R REDDY
4. DR M MRITYUNJYA
5. DR SRINIVAS REDDY
1. A C PRABU
2. AKETI SRINU
3. PRASAD
4. DR A ANIL KUMAR
1. DR PRIYASHA DAMODARA
2. DR PREMCHAND A
3. DR MOHANPRIYA A
4. DR KEERTHIGA K
1. SISTER SRITHA
2. SISTER VENKATLAXMI
ROSE CASE MOULD BRACHY FOR UVULA

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