GUIDELINES FOR THE MANAGEMENT OF SKULL BASE TUMOURS. Version: 1 AngCN-SSG-BC6
|
|
- Clifton Wood
- 6 years ago
- Views:
Transcription
1 GUIDELINES FOR THE MANAGEMENT OF SKULL BASE TUMOURS Version: 1 Ref: AngCN-SSG-BC6
2 CONTENTS Page No 1 Introduction Imaging Other investigations Referral Accepting referrals MDT Meeting Vestibular Schwannoma / Acoustic Neuroma Management Policy Surveillance Surgery Radiotherapy Single fraction radiosurgery Fractionated conformal radiotherapy Neurofibromatosis Type Surveillance Surgery RT -Treatment Planning Immobilisation Imaging Planning Target Volume Dose Prescription Implementation Glomus Tumours Treatment Policy Surgical management Radiotherapy Treatment Planning Target Volume Dose Prescription Implementation... 9 Page 2 of 13
3 7 Chordoma / Chondrosarcoma Treatment Policy Radiotherapy Treatment Planning Target Volume Dose Prescription Implementation Squamous Cell Carcinoma (SCC) of the Temporal Bone Diagnosis Management APPENDICES Appendix A: Document Management and Approval Page 3 of 13
4 1 Introduction These protocols represent the treatment policy for skull base tumours and are intended as guidance to those working within the Anglia Cancer Network. While every effort has been made to ensure that the guidelines are accurate and unambiguous it must be emphasised that constant modifications will be necessary. These protocols should only be used to give an indication of current management. We do not guarantee the accuracy of these protocols and do not accept any liability if they are used outside of the Anglia Cancer Network. 2 Imaging MR imaging is a highly sensitive investigation for the identification of skull base tumours. All patients with a suspected skull base tumour must have an MRI scan that as a minimum includes T1, T2 and T1 with gadolinium. If a skull base tumour is identified using a screening MR protocol, patients should be asked to return for a full investigation protocol. 2.1 Other investigations In order to speed up referral to the designated skull base unit, it is advised that further investigation is not performed. MR imaging is made available via Link for discussion at the skull base MDT. 3 Referral By the nature of patient symptoms, there is often significant delay referring patients to the skull base MDT for definitive treatment. GP referral to the local ENT Dept, MR imaging, follow up appointment to inform the patient of the diagnosis and then referral to the skull base MDT can bring patients very close to or past the 18 week target. With this in mind, it is essential that once a diagnosis has been made, urgent review and then referral be organised. Rare malignant tumours of the skull base should be referred via the 2 week cancer pathway to the skull base MDT. Patients must be referred to a member of the skull base team by letter that is both posted and faxed. The referral is then passed on to the skull base MDT coordinator for an appointment to be booked in the next clinic. All investigations must be completed and on the Addenbrooke s PACS or Link System by the Wednesday evening on the week of the skull base MDT. 3.1 Accepting referrals When receiving the initial referral the MDT coordinator should record patient name, age, referring team details, patient location, history and co-morbidities. The MDT coordinator should ask that all films be sent via the image link or by CD by the Wednesday evening on the week of the skull base MDT. Page 4 of 13
5 The MDT coordinator should then pass all new patient details to the Skull Base Fellow for preparation of the skull base MDT. It is the responsibility of the Skull Base Fellow to forward patient details to the neuroradiologist in good time so that he can prepare the images for the meeting the following morning. 3.2 MDT Meeting The skull base MDT meeting occurs on Friday morning from am weeks 2 & 4 of the month. All cases referred over the previous 14 days are discussed and a management plan agreed. Patient details are presented by the skull base fellow or nominated deputy in his absence. A video link with the Oncology teams in Ipswich and Norfolk & Norwich enable a clear treatment plan at both the skull base centre and local oncology units. All enquiries should initially be directed to the MDT Coordinator or Clinical Nurse Specialists. 4 Vestibular Schwannoma / Acoustic Neuroma 4.1 Management Policy For patients diagnosed with vestibular Schwannoma there are a number of management strategies available: 4.2 Surveillance Vestibular Schwannomas are often diagnosed when small, before compression of the brainstem. These tumours are usually slow growing and a watch wait rescan policy can be adopted. Regular surveillance scans adopting a clear rescan protocol is essential until patient age dictates no further scans are required. If tumour growth does occur, another treatment option can be adopted without significant change in patient morbidity. 4.3 Surgery Surgery is an excellent treatment, provided complete excision is achieved without undue morbidity. Surgery achieves complete excision in over 97% of patients and surgical mortality or serious intracranial adverse event is below 1%. The main concern to patients is the risk of facial nerve injury (Appendix H). The possibility of facial weakness increases with increasing tumour size. For small tumours, the risk is below 5%. For tumours over 3cm, the risk increases to between 20 and 30%. Hearing preservation surgery is possible if patients have useful pre-operative hearing which is regarded as better than 70% speech discrimination and pure tone average threshold below 30dB. Hearing preservation surgery should only be considered if the patient regards hearing preservation as a major surgical objective and the tumour is medially placed within the internal auditory meatus. Page 5 of 13
6 Patients can expect a post-operative recovery period of between 6 weeks to 3 months. Persistent imbalance especially in the elderly can be a problem. Surgical excision is performed in two defined patient groups: Large tumours where radiotherapy is not an option and if left risks serious morbidity/mortality. Smaller growing tumours where the patient does not want further observation and does not want radiotherapy. 4.4 Radiotherapy Radiotherapy is an alternative to surgery and can be delivered in two ways: Single fraction radiosurgery (Gamma Knife) Fractionated conformal radiotherapy Single fraction radiosurgery For small ( 3cm) laterally placed lesions, stereotactic radiosurgery is an excellent choice. At present patients seeking an opinion on radiosurgery should be referred to a Gamma Knife Centre (Royal London or Sheffield) Fractionated conformal radiotherapy For larger lesions and those lesions adjacent to or compressing the brain stem fractionated conformal radiotherapy is a worthwhile treatment. Ideally to reduce PTV margins (normal tissue irradiated) patients should be immobilised in the relocatable SRT frame, however a shell can be used if more appropriate. For patients who have useful hearing this option may preserve hearing. However radiotherapy is designed to stabilize the tumour and will not remove the lesion, so patients will require an active follow up plan. Published results for fractionated radiotherapy suggest excellent efficacy and low morbidity (Fuss et al). 5 Neurofibromatosis Type 2 Neurofibromatosis type 2 (NF2) is an autosomal dominant condition characterised by multiple benign intracranial tumours usually centred on the auditory nerve. Patients with NF2 are at a greater risk of multiple cranial nerve deficits. Patients are referred to a unit specialising the management of this complex condition. Funding for the management of this condition is from the National Commissioning Group (NCG) 5.1 Surveillance It is important to maintain cranial nerve function if at all possible. With this in mind, surveillance is usually adopted until intervention is necessary either because of persistent tumour growth or profound/total hearing loss or other cranial nerve deficit that requires intervention. Page 6 of 13
7 5.2 Surgery Surgery is the treatment of choice if there is evidence of persistent tumour growth or significant cranial nerve deficit. Total tumour removal with preservation of residual cranial nerve function is important. Hearing implants can restore a degree of hearing loss in certain, well defined cases. Radiotherapy: Single dose radiosurgery is currently the only option funded by the NCG. Gamma knife is offered at the only designated centre in Sheffield. It is usually offered to patients that have a rapidly growing tumour in an only hearing ear or after failed surgery. Chemotherapy: Chemotherapeutic agents have recently been used to some effect for the control aggressive uncontrolled disease. Bevacizumab is currently funded by the NCG for patients who fulfil strict inclusion criteria. 5.3 RT -Treatment Planning Immobilisation Relocatable SRT head frame patients who are Performance Status (PS) 0 with good upper jaw dentition Perspex beam direction shell - supine Imaging Neuro CT planning scan with IV contrast - 1mm slices throughout the brain MRI - with 2mm contiguous slices for T1W+Gd sequence CT: MR co-registration - to T1W+Gd sequence Planning Conformal radiotherapy planning use of personalised shielding blocks or mmlc Target Volume GTV: the enhancing lesion as demonstrated on T1W + Gd MR sequence CTV: = GTV PTV: This margin should be grown isotropically with the planning software. Stereotactic frame CTV - PTV margin is 0.3cm. Beam Direction Shell - the standard CTV - PTV margin is 0.5cm. Critical normal structures: these should be outlined including the eyes, lenses, brain stem and the pituitary. Page 7 of 13
8 5.3.5 Dose Prescription 50Gy/30# Implementation Always measure eye TLDs for future reference. Take portal films or images as per protocol. Please see Appendix H for the Vestibular Schwannoma Assessment diagram. 6 Glomus Tumours 6.1 Treatment Policy The decision between surgery and radiotherapy may be difficult and needs to be considered individually. The most important factor dictating treatment choice is residual lower cranial nerve function. Sudden loss of lower cranial nerve function can be catastrophic, resulting in persistent aspiration requiring a tracheotomy, poor voice and difficulty feeding resulting n the placement of a PEG. Planning management must therefore always take into account lower cranial nerve function. 6.2 Surgical management Total surgical excision should be the treatment of choice for small Fisch type A or B tumours centred either on the promontory of the cochlea or within the middle ear. These tumours are often not involving the jugular bulb and there is little risk to lower cranial nerve function. Patients main complaint is conductive hearing loss and pulsatile tinnitus, which often resolve after surgical excision. Total surgical excision should also be considered if patients present with slowly progressive complete vagal and glossopharyngeal palsy. The progressive loss of lower cranial nerve function often enables the patient to adapt to that loss and manage to eat and drink without significant aspiration. Surgical tumour removal is unlikely to cause further significant loss of function although the risk to other cranial nerves including VII, VIII, XI should always be considered. Partial surgical excision should be considered for patients who have lower cranial nerve function and debilitating symptoms for example pulsatile tinnitus. Partial tumour removal, leaving a remnant centred on the jugular bulb offers symptomatic relief with a low risk lower cranial function. Postoperative radiotherapy is then advised for control of tumour remnant. 6.3 Radiotherapy Radiotherapy has the advantage of very low toxicity, but the disadvantages that the tumour remains and late tumour regrowth occurrence or second tumours can occur. The risk of this is very low. Page 8 of 13
9 Local control rates are reported to be high after radiotherapy, with moderate doses, in the range 90-93% (Springate et al 1990, 1991). In one report, the majority of patients noted symptomatic relief of tinnitus after radiation, but objective neurological deficits usually remained unchanged or showed only partial improvement (Powell et al 1992) Treatment Planning Use a beam-direction shell or stereotactic radiotherapy frame, depending on circumstances. For tumours with any significant extension into the neck, the SRT frame is not suitable. Use CT planning, with IV contrast, which show glomus tumours quite well. CT slices spacing is normally The CT should cover the whole head to allow the possibility of noncoplanar beams (and NTCP calculations), and must extend low enough in the neck to cover the inferior extent. For large, low lesions a mouth bite may be useful. CT: MR image co-registration is often valuable, and may be essential. Some additional localisation information is often available from the angiogram Target Volume Plan conformally, usually with CT: MR co-registration. The CTV is essentially the GTV, with or without an allowance for uncertainty in localisation and co-registration. Always review the CT at bone window settings. The standard CTV - PTV margin for patients in a shell is 0.5 cm, while for patients in the stereotactic frame the margin is 0.3 cm. This margin should be grown tropically with the planning software. Outline critical normal structures, including the pituitary, the eyes, the parotid glands, brain stem etc Dose Prescription 50 Gy / 30 # at 1.67 Gy/# 1 phase. In exceptional circumstances consider a slightly higher dose, of 55 Gy / 33 # Implementation Always measure eye TLDs for future reference. Take portal films or images as per protocol. Very occasional patients experience nausea, especially when the brain stem is irradiated. This is usually manageable with 5-HT3 antagonists. Patients rarely require steroids. Page 9 of 13
10 7 Chordoma / Chondrosarcoma 7.1 Treatment Policy Aim for maximum surgical resection. Follow with referral for proton therapy via the National Proton Group (leedsth-tr.protonncg@nhs.net). If not suitable for proton therapy for high dose stereotactic radiotherapy or Image Guided Radiotherapy. 7.2 Radiotherapy Treatment Planning Use the stereotactic radiotherapy frame. Use CT planning, with IV contrast, and slice spacing of Always scan the whole head, for improved DRRs and NTCP calculations, though spacing may be larger outside the target region. CT: MR image co-registration is essential Target Volume Plan conformally, with CT: MR co-registration. Treat in 2 phases. For Phase 1, the CTV is essentially the pre-op GTV, with or without an allowance for uncertainty in localisation. For Phase 2, the CTV is the post-op GTV. Add the stereotactic frame PTV margin of 0.3 cm. Outline critical normal structures, including the pituitary, the eyes and lenses, and often the optic nerves and chiasm. Grow these into PRVs. For further planning details see below Dose Prescription This is very individual. Aim for Gy, optimising physical planning and fractionation Implementation Always measure eye TLDs for future reference. Take portal films or images as per protocol. Page 10 of 13
11 8 Squamous Cell Carcinoma (SCC) of the Temporal Bone SCC of the temporal bone is rare. It usually presents with a painful bloody discharge from the ear. 8.1 Diagnosis It is important to forward histology slides to the skull base MDT for review by the Skull Base pathologist. This enables confirmation of diagnosis and grade. Pre-operative MR of the head and neck as well as CT of the head, neck, chest and abdomen are required before surgical planning. 8.2 Management SCC of the temporal bone can invade adjacent structures for example the temporomandibular joint, dura and brain. Management is centered on the need to achieve complete macroscopic surgical excision of the tumour followed by radiotherapy. Factors favouring good treatment outcome: Well or moderately differentiated histological grade No involvement of the brain No 0 disease Involvement of the facial nerve is the factor that best predicts the need to perform either a lateral or total temporal bone resection. Both surgical procedures require the removal of the head of the mandible and glenoid. Facial nerve preservation rates are high following lateral temporal bone resection. The reconstructive surgical team performs free flap repair of the surgical defect. It is rare for the pinna to be preserved as it is almost always infiltrated with tumour. The patient is admitted onto the Plastic Surgical ward for post-operative monitoring of the free-flap before discharge. Post-operative radiotherapy is planned by the local oncology team. Page 11 of 13
12 9 APPENDICES 9.1 Appendix A: Document Management and Approval These Guidelines have been approved by the Network Board in December 2010 and as follows: The Skull Base SMDT Lead Clinician Name: Mr Patrick Axon Organisation: CUHFT The Brain CNS SSG Chair Name: Sarah Jefferies Organisation: CUHFT The AngCN Medical Director Name: Rory Harvey The AngCN Chair Name: Paul Watson Organisation: Anglia Cancer Network Organisation: Anglia Cancer Network Document management Document ratification and history Approved by: Network Board, Patrick Axon, Rory Harvey and Paul Watson. Date approved: December 2010 Date placed on electronic library: December 2010 Reviewed and Review period: 1 year Authors: Patrick Axon and Neil Donnelly, SMDT Chair and Deputy Chair Document Owner: Anglia Cancer Network Tel: Version number as approved and published: 1 Unique identifier no.: AngCN-SSG-BC6 For clinical comments / amendments to the guidelines, please contact: Clinical Panel Name Hospital Tel. No Patrick Axon Addenbrookes Patrick.axon@addenbrookes.nhs.uk Neil Donnelly Addenbrookes Neil.donnelly@addenbrookes.nhs.uk Sarah Jefferies Addenbrookes sarah.jefferies@addenbrookes.nhs.uk For copies of guidelines, please refer to the Anglia Cancer Network website: Page 12 of 13
13 Page 13 of 13
NON MALIGNANT BRAIN TUMOURS Facilitator. Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol
NON MALIGNANT BRAIN TUMOURS Facilitator Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol Neurosurgery What will be covered? Meningioma Vestibular schwannoma (acoustic neuroma)
More informationStereotactic Radiosurgery/Fractionated Stereotactic Radiotherapy for Acoustic Neuroma (Vestibular Schwannomas)
Strategic Commissioning Group West Midlands Commissioning Policy (WM/38) Stereotactic Radiosurgery/Fractionated Stereotactic Radiotherapy for Acoustic Neuroma (Vestibular Schwannomas) Version 1 July 2010
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION
More informationOtolaryngologist s Perspective of Stereotactic Radiosurgery
Otolaryngologist s Perspective of Stereotactic Radiosurgery Douglas E. Mattox, M.D. 25 th Alexandria International Combined ORL Conference April 18-20, 2007 Acoustic Neuroma Benign tumor of the schwann
More informationBrain and CNS tumours Presentation pathway
Brain and CNS tumours Presentation pathway Ref: AngCN-SSG-BC16 Page 1 of 8 1 Background and Scope This presentation pathway deals with the pathway of referral from all aspects of primary care to hospitals
More informationPATHWAY MANAGEMENT OF METASTATIC SPINAL CORD COMPRESSION (MSCC) THE CHRISTIE, GREATER MANCHESTER & CHESHIRE
PATHWAY MANAGEMENT OF METASTATIC SPINAL CORD COMPRESSION (MSCC) THE CHRISTIE, GREATER MANCHESTER & CHESHIRE Procedure Reference: Document Owner: Dr V. Misra Version: Accountable Committee: V3 MSCC Network
More informationClinical Guidelines for the Management of Neuro-Oncology
Clinical Guidelines for the Management of Neuro-Oncology For approvals and version control see Document Management Record on page 37 Version: 3 Ref: AngCN_SSG_BC3_v3_NeuroOncology_Guidlines Page 1 of 47
More informationInformation for patients. Acoustic Neuroma. Neurosurgery: Neurosciences. Supported by
Information for patients Acoustic Neuroma Neurosurgery: Neurosciences Supported by What is an Acoustic Neuroma You have been diagnosed as having an acoustic neuroma. An acoustic neuroma also known as a
More informationParaganglioma of the Skull Base. Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI
Paraganglioma of the Skull Base Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI Case Presentation 63-year-old female presents with right-sided progressive conductive hearing loss for several
More informationSpecialised Services Policy: CP22. Stereotactic Radiosurgery
Specialised Services Policy: CP22 Document Author: Assistant Director of Planning Executive Lead: Director of Planning ad Performance Approved by: Management Group Issue Date: 01 July 2015 Review Date:
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM BRAIN METASTASES CNS Site Group Brain Metastases Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION
More informationSkull Base Tumour Service. The Multi-Disciplinary Team (MDT) Explained. Jan 2018 v1
Skull Base Tumour Service The Multi-Disciplinary Team (MDT) Explained Jan 2018 v1 Skull base tumours grow in the bones of the skull that form the bottom of the head and the body ridge between the nose
More informationHead and neck cancer - patient information guide
Head and neck cancer - patient information guide The development of reconstructive surgical techniques in the last 20 years has led to major advances in the treatment of patients with head and neck cancer.
More informationSTATE OF THE ART MANAGEMENT of PARAGANGLIOMA. IFOS, Lima, 2018
STATE OF THE ART MANAGEMENT of PARAGANGLIOMA IFOS, Lima, 2018 VINCENT C COUSINS ENT-Otoneurology Unit, The Alfred Hospital & Department of Surgery, Monash University MELBOURNE, AUSTRALIA PARAGANGLIOMAS
More informationDosimetry, see MAGIC; Polymer gel dosimetry. Fiducial tracking, see CyberKnife radiosurgery
Subject Index Acoustic neuroma, neurofibromatosis type 2 complications 103, 105 hearing outcomes 103, 105 outcome measures 101 patient selection 105 study design 101 tumor control 101 105 treatment options
More informationNCCN GUIDELINES ON PROTON THERAPY (AS OF 4/23/18) BONE (Version , 03/28/18)
BONE (Version 2.2018, 03/28/18) NCCN GUIDELINES ON PROTON THERAPY (AS OF 4/23/18) Radiation Therapy Specialized techniques such as intensity-modulated RT (IMRT); particle beam RT with protons, carbon ions,
More informationFractionated Stereotactic Radiotherapy. Rationale, indications, & treatment techniques
Fractionated Stereotactic Radiotherapy Rationale, indications, & treatment techniques Radiobiological principles The BED (Gy) = D(1 + d/α/β) Assume BED 1 = BED 2 for tissue of an unknown α/β: Optic
More informationSTEREOTACTIC RADIATION THERAPY. Monique Blanchard ANUM Radiation Oncology Epworth HealthCare
STEREOTACTIC RADIATION THERAPY Monique Blanchard ANUM Radiation Oncology Epworth HealthCare Overview Stereotactic radiation therapy at Epworth Healthcare What is stereotactic radiation therapy? Delivery
More informationUCLH NHS Foundation Trust. Patient Guide to Gamma Knife Radiosurgery for Pituitary Tumours. at The Queen Square Radiosurgery Centre
UCLH NHS Foundation Trust Patient Guide to Gamma Knife Radiosurgery for Pituitary Tumours at The Queen Square Radiosurgery Centre Gamma Knife Radiosurgery for Pituitary Tumours This booklet provides brief
More informationC. Martin Harris, M.D., M.B.A. Holly D. Miller, M.D., M.B.A.
C. Martin Harris, M.D., M.B.A. Holly D. Miller, M.D., M.B.A. HIMSS 2003 Who We Are C. Martin Harris, M.D., M.B.A. Chief Information Officer Executive Director of e-cleveland Clinic Holly D. Miller, M.D.,
More informationSTEREOTACTIC RADIOTHERAPY FOR
STEREOTACTIC RADIOTHERAPY FOR MENINGIOMA PATIENT INFORMATION LEAFLET STEREOTACTIC RADIOTHERAPY FOR MENINGIOMA You have recently been diagnosed with a meningioma. This leaflet will explain what these are
More informationBrain Tumor Treatment
Scan for mobile link. Brain Tumor Treatment Brain Tumors Overview A brain tumor is a group of abnormal cells that grows in or around the brain. Tumors can directly destroy healthy brain cells. They can
More informationACOUSTIC NEUROMAS. Being invited to Florence, Italy to address an international medical meeting about our work for
ACOUSTIC NEUROMAS Being invited to Florence, Italy to address an international medical meeting about our work for head and neck tumors was a great honor. The symposium organized under the auspices of the
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM EPENDYMOMA Last Revision Date July 2015 1 CNS Site Group Ependymoma Author: Dr. Norm Laperriere 1. INTRODUCTION 3 2.
More informationAcoustic Neuroma. Hope Building Ward H
Acoustic Neuroma Hope Building Ward H7 0161 206 2303 All Rights Reserved 2017. Document for issue as handout. What is Acoustic Neuroma? You have been diagnosed as having an acoustic neuroma. This is a
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM LOW GRADE GLIOMAS CNS Site Group Low Grade Gliomas Author: Dr. Norm Laperriere 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING
More informationRadiotherapy Protocols
Radiotherapy Protocols Cranial Irradiation for Palliative Whole Brain for Metastases and Prophylactic Whole Brain for SCLC Prepared by: Dr C Blesing, Dr N Warner, Dr D Cutter, Ms R Watson, Ms L Drummond,
More informationBackground Principles and Technical Development
Contents Part I Background Principles and Technical Development 1 Introduction and the Nature of Radiosurgery... 3 Definitions of Radiosurgery... 5 Consequences of Changing Definitions of Radiosurgery...
More informationStereotactic Radiotherapy for Acoustic Neuromas (CyberKnife) UHB is a no smoking Trust
Stereotactic Radiotherapy for Acoustic Neuromas (CyberKnife) UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
More informationBrain and Central Nervous System Cancers
Brain and Central Nervous System Cancers NICE guidance link: https://www.nice.org.uk/guidance/ta121 Clinical presentation of brain tumours History and Examination Consider immediate referral Management
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/36461 holds various files of this Leiden University dissertation Author: Wiggenraad, Ruud Title: Stereotactic radiotherapy of intracranial tumors : optimizing
More informationGamma Knife Radiosurgery A tool for treating intracranial conditions. CNSA Annual Congress 2016 Radiation Oncology Pre-congress Workshop
Gamma Knife Radiosurgery A tool for treating intracranial conditions CNSA Annual Congress 2016 Radiation Oncology Pre-congress Workshop ANGELA McBEAN Gamma Knife CNC State-wide Care Coordinator Gamma Knife
More informationRefresher Course EAR TUMOR. Sasikarn Chamchod, MD Chulabhorn Hospital
Refresher Course EAR TUMOR Sasikarn Chamchod, MD Chulabhorn Hospital Reference: Perez and Brady s Principles and Practice of radiation oncology sixth edition Outlines Anatomy Epidemiology Clinical presentations
More informationAdvanced Radiotherapy
CANCER TREATMENT: advanced RadiotherapY Advanced Radiotherapy The information in this factsheet will help you to understand more about advanced radiotherapy treatments for cancer. It can be read along
More informationMohs surgery. Information for patients Dermatology
Mohs surgery Information for patients Dermatology Why have I been given this leaflet? You have been given this leaflet because you are going to have a procedure known as Mohs surgery. This leaflet explains
More informationSkull base cancers. Information for patients Neurosurgery
Skull base cancers Information for patients Neurosurgery What is a skull base cancer? Your doctor will confirm with you the nature of your skull base cancer. Many skull base cancers are actually malignant
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM GERM CELL TUMOURS CNS Site Group Germ Cell Tumours Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION
More informationWest Midlands Sarcoma Advisory Group
West Midlands Sarcoma Advisory Group Guideline for the Initial Investigation and Referral to Specialist Sarcoma Multi Disciplinary Team for Suspected Bone Sarcoma Version History Version Date Brief Summary
More informationOriginal Date: April 2016 Page 1 of 7 FOR CMS (MEDICARE) MEMBERS ONLY
National Imaging Associates, Inc. Clinical guidelines STEREOTACTIC RADIATION THERAPY: STEREO RADIOSURGERY (SRS) AND STEREOTACTIC BODY RADIATION THERAPY (SBRT) CPT4 Codes: Please refer to pages 5-6 LCD
More informationGuideline for the Follow-up of Patients with Gynaecological Malignancies
Guideline for the Follow-up of Patients with Gynaecological Malignancies Version History Version Date Summary of Change/Process 2.0 20.02.08 Endorsed by the Governance Committee 2.1 18.11.10 Circulated
More informationAdvanced Technology Consortium (ATC) Credentialing Procedures for 3D Conformal Therapy Protocols 3D CRT Benchmark*
Advanced Technology Consortium (ATC) Credentialing Procedures for 3D Conformal Therapy Protocols 3D CRT Benchmark* Purpose: To evaluate an institution s 3D treatment planning process and the institution
More informationCapt. Nazim ATA Aerospace Medicine Specialist Turkish Air Force AAMIMO 2013
F-15 Pilot with ACOUSTIC NEUROMA Capt. Nazim ATA Aerospace Medicine Specialist Turkish Air Force AAMIMO 2013 Disclosure Information 84 th Annual AsMA Scientific Meeting Nazim ATA I have no financial relationships
More informationSaturday 25th August Queensland Acoustic Neuroma Conference. The 7th Biennial David Brown-Rothwell Memorial
Princess Alexandra Hospital Qld Skull Base Unit PAH in association with Qld Acoustic Neuroma Association & Audiology Australia The 7th Biennial Queensland Acoustic Neuroma Conference Convenors: The Queensland
More informationNational Optimal Lung Cancer Pathway
National Optimal Lung Cancer Pathway This document was produced by the Lung Clinical Expert Group 2017 Document Title: National Optimal Lung Cancer Pathway and Implementation Guide Date of issue: August
More informationUpdate on Pediatric Brain Tumors
Update on Pediatric Brain Tumors David I. Sandberg, M.D. Director of Pediatric Neurosurgery & Associate Professor Dr. Marnie Rose Professorship in Pediatric Neurosurgery Pre-talk Questions for Audience
More informationSelected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary
Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary László Bognár M.D., Ph.D., József G. Dobai M.D., Gábor Csiky and Imre Fedorcsák M.D., Ph.D. Department of Neurosurgery, Medical
More informationFaster Cancer Treatment Indicators: Use cases
Faster Cancer Treatment Indicators: Use cases 2014 Date: October 2014 Version: Owner: Status: v01 Ministry of Health Cancer Services Final Citation: Ministry of Health. 2014. Faster Cancer Treatment Indicators:
More informationERN services: A Patient Case Study. Matt Johnson, EURORDIS Potential ERN Services Second Workshop, PWC, Brussels 24 May 2016
ERN services: A Patient Case Study Matt Johnson, EURORDIS Potential ERN Services Second Workshop, PWC, Brussels 24 May 2016 1 Collective knowledge and expertise A European Reference Network is more than
More informationLeksell Gamma Knife Icon. Treatment information
Leksell Gamma Knife Icon Treatment information You may be feeling frightened or overwhelmed by your recent diagnosis. It can be confusing trying to process a diagnosis, understand a new and challenging
More informationSELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM)
SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT MDT Lead Clinician GMCN ROYAL WOLVERHAMPTON HOSPITALS The Royal Wolverhampton Hospitals Trust Lung MDT (11-2C-1) - 2011/12 Dr Angela Morgan
More informationMohs Micrographic Surgery
University Teaching Trust Mohs Micrographic Surgery Irving Building Dermatology Outpatients 0161 206 1021 All Rights Reserved 2018. Document for issue as handout. Mohs Micrographic Surgery is a treatment
More informationBrain tumors: tumor types
Brain tumors: tumor types Tumor types There are more than 120 types of brain tumors. Today, most medical institutions use the World Health Organization (WHO) classification system to identify brain tumors.
More informationIf you have any further questions, please speak to a doctor or nurse caring for you.
Surgical Removal of a Paraganglioma of the Temporal Bone This leaflet explains more about surgery for the removal of a paraganglioma of the temporal bone, including the benefits, risks and any alternatives
More informationOncological Management of Brain Tumours. Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013
Oncological Management of Brain Tumours Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013 Outline General considerations of Primary Brain Tumours: epidemiology, pathology, presentation. Diagnosis
More information4D Radiotherapy in early ca Lung. Prof. Manoj Gupta Dept of Radiotherapy & oncology I.G.Medical College Shimla
4D Radiotherapy in early ca Lung Prof. Manoj Gupta Dept of Radiotherapy & oncology I.G.Medical College Shimla Presentation focus on ---- Limitation of Conventional RT Why Interest in early lung cancer
More informationDr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis
Dr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis Schwannomas (also called neurinomas or neurilemmomas) constitute the most common primary cranial nerve tumors. They are benign slow-growing
More informationGuidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer
Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM ANAPLASTIC GLIOMAS CNS Site Group Anaplastic Gliomas Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION
More informationThe Physics of Oesophageal Cancer Radiotherapy
The Physics of Oesophageal Cancer Radiotherapy Dr. Philip Wai Radiotherapy Physics Royal Marsden Hospital 1 Contents Brief clinical introduction Imaging and Target definition Dose prescription & patient
More informationEvaluation of Monaco treatment planning system for hypofractionated stereotactic volumetric arc radiotherapy of multiple brain metastases
Evaluation of Monaco treatment planning system for hypofractionated stereotactic volumetric arc radiotherapy of multiple brain metastases CASE STUDY Institution: Odette Cancer Centre Location: Sunnybrook
More informationCollection of Recorded Radiotherapy Seminars
IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org The Role of Radiosurgery in the Treatment of Gliomas Luis Souhami, MD Professor Department of Radiation
More informationNICE Quality Standards and COF
NICE Quality Standards and COF David Baldwin Consultant Respiratory Physician NUH Hon Senior Lecturer Nottingham University Clinical lead NICE lung cancer GL Chair NICE QS Topic Expert Group Quality Standards
More informationThe Urology One-Stop Clinic
The Urology One-Stop Clinic Exceptional healthcare, personally delivered The aim of this leaflet is to answer any questions you may have about the Urology One-Stop Clinic. What is the Urology One-Stop
More informationWest Midlands Sarcoma Advisory Group
West Midlands Sarcoma Advisory Group Guideline for the Initial Investigation and Referral to Sarcoma Specialist Multi Disciplinary Team for Suspected Sarcoma of Soft Tissue Extremities (limbs and trunk
More informationScans in Neurofibromatosis
Scans in Neurofibromatosis A scan creates an image or picture of internal organs of the body such as bone or soft tissue. Scans are used by doctors to help to identify the cause of your symptoms. Your
More informationBLADDER RADIOTHERAPY PLANNING DOCUMENT
A 2X2 FACTORIAL RANDOMISED PHASE III STUDY COMPARING STANDARD VERSUS REDUCED VOLUME RADIOTHERAPY WITH AND WITHOUT SYNCHRONOUS CHEMOTHERAPY IN MUSCLE INVASIVE BLADDER CANCER (ISRCTN 68324339) BLADDER RADIOTHERAPY
More informationClinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Skull Base Tumour Treatment NHS Overseas Programme (Adult)
Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Skull Base Tumour Treatment NHS Overseas Programme (Adult) Reference: NHS England B01/P/d NHS England INFORMATION READER BOX Directorate
More informationPEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING
PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING ANATOMY ANATOMY CONT ANATOMY CONT. ANATOMY CONT. EYE OF A CHILD Normal tissue tolerance doses (in conventional #) TD 5/5 TD 50/5 Endpoint Gy Gy Optic nerve
More informationPLASTICS Referral Guidelines
PLASTICS Referral Guidelines Austin Health PLASTICS Unit holds fortnightly multidisciplinary meetings with ENT/ Maxillary Facial and Oncology Units to discuss and plan the treatment of patients with cancerous
More informationTransforming Cancer Services for London
Programme Director Paul Roche Status Draft Owner Laura Boyd Version 0.4 Author Jennifer Layburn Date 15/05/13 Transforming Cancer Services for London Best Practice Commissioning Pathway for the early detection
More informationRestorative dentistry new patient clinic
Restorative dentistry new patient clinic You have been referred to the Restorative Dentistry Service for an assessment regarding a specific dental problem, and this leaflet provides information about your
More informationSingle Suspected Cancer Pathway Definitions pathway start date
Single Suspected Cancer Pathway Definitions pathway start date Date: December 2018 Version: 8.0 Wales Cancer Owner: Network and Welsh Government Status Draft 1 P a g e Purpose of Document This document
More informationACOUSTIC NEUROMAS. University of Florida ENT Clinic Patrick J. Antonelli, MD Matthew R. O Malley, MD
ACOUSTIC NEUROMAS University of Florida ENT Clinic Patrick J. Antonelli, MD Matthew R. O Malley, MD Rev. 10.31.2011 ACOUSTIC TUMORS Acoustic tumors are non-malignant fibrous growths, originating from the
More informationTreatment Planning Evaluation of Volumetric Modulated Arc Therapy (VMAT) for Craniospinal Irradiation (CSI)
Treatment Planning Evaluation of Volumetric Modulated Arc Therapy (VMAT) for Craniospinal Irradiation (CSI) Tagreed AL-ALAWI Medical Physicist King Abdullah Medical City- Jeddah Aim 1. Simplify and standardize
More informationMeningioma tumor. Meningiomas are named according to their location (Fig. 1) and cause various symptoms: > 1
Meningioma tumor Overview A meningioma is a type of tumor that grows from the protective membranes, called meninges, which surround the brain and spinal cord. Most meningiomas are benign (not cancer) and
More informationNational Cancer Peer Review Sarcoma. Julia Hill Acting Deputy National Co-ordinator
National Cancer Peer Review Sarcoma Julia Hill Acting Deputy National Co-ordinator Improving Outcomes Guidance The Intentions of Improving Outcomes for People with Sarcoma Changes in the provision of care
More informationGuidelines for the Management of Suspected Sarcoma in Primary Care
Guidelines for the Management of Suspected Sarcoma in Primary Care Author: Anglia Cancer Network Sarcoma SSG Document Approved Date: 16-Dec-10 Review Date: December 2012 Ref Code: AngCN-SSG-Sa1 Status:
More informationUpdate on Management of Malignant Spinal Cord Compression. Heino Hugel Consultant in Palliative Medicine University Hospital Aintree
Update on Management of Malignant Spinal Cord Compression Heino Hugel Consultant in Palliative Medicine University Hospital Aintree Current Guidelines The symptoms of MSCC may be subtle and therefore careful
More informationPediatr Blood Cancer 2014
Low grade Glioma! 40% of pediatric brain tumors Pathologically, anatomically, clinically and biologically heterogeneous Leptomeningeal metastases in 5% Frequently protracted clinical course Long-Term Outcome
More informationGoals and Objectives: Head and Neck Cancer Service Department of Radiation Oncology
Goals and Objectives: Head and Neck Cancer Service Department of Radiation Oncology The head and neck cancer service provides training in the diagnosis, management, treatment, and follow-up care of head
More informationBrain Tumors. What is a brain tumor?
Scan for mobile link. Brain Tumors A brain tumor is a collection of abnormal cells that grows in or around the brain. It poses a risk to the healthy brain by either invading or destroying normal brain
More informationEvaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer
1 Charles Poole April Case Study April 30, 2012 Evaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer Abstract: Introduction: This study
More informationAdvances in external beam radiotherapy
International Conference on Modern Radiotherapy: Advances and Challenges in Radiation Protection of Patients Advances in external beam radiotherapy New techniques, new benefits and new risks Michael Brada
More informationUCLH NHS Foundation Trust. Patient Guide to Gamma Knife Radiosurgery. at The Queen Square Radiosurgery Centre
UCLH NHS Foundation Trust Patient Guide to Gamma Knife Radiosurgery at The Queen Square Radiosurgery Centre Gamma Knife Radiosurgery This booklet provides brief information about Gamma Knife radiosurgery
More informationSTEREOTACTIC RADIOSURGERY FOR
STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES PATIENT INFORMATION LEAFLET STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES You have recently been diagnosed with one or more brain metastases. This leaflet
More informationProtocol of Radiotherapy for Head and Neck Cancer
106 年 12 月修訂 Protocol of Radiotherapy for Head and Neck Cancer Indication of radiotherapy Indication of definitive radiotherapy with or without chemotherapy (1) Resectable, but medically unfit, or high
More informationAbstractID: 8073 Title: Quality Assurance, Planning and Clinical Results for Gamma Knife Radiosurgery S. Goetsch, Ph.D. Page 1 Seattle, WA May 2008
Knife Radiosurgery S. Goetsch, Ph.D. Page 1 Quality Assurance, Planning and Clinical Results for Gamma Knife Radiosurgery Steven J. Goetsch, Ph.D., FAAPM ACMP 25 th Annual Meeting Seattle, WA May 2008
More informationEffectiveness and Safety of Spot Scanning Proton Radiation Therapy for Skull Base Tumors: First Long Term Report of the PSI Experience
Effectiveness and Safety of Spot Scanning Proton Radiation Therapy for Skull Base Tumors: First Long Term Report of the PSI Experience Carmen Ares, Antony J Lomax, Eugen B Hug, Alessandra Bolsi, Beate
More informationIntensity Modulated Radiation Therapy (IMRT)
Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 03/01/2015 Section: Radiology
More informationStereotactic Radiosurgery. Extracranial Stereotactic Radiosurgery. Linear accelerators. Basic technique. Indications of SRS
Stereotactic Radiosurgery Extracranial Stereotactic Radiosurgery Annette Quinn, MSN, RN Program Manager, University of Pittsburgh Medical Center Using stereotactic techniques, give a lethal dose of ionizing
More informationGUIDELINES FOR RADIOTHERAPY IN SPINAL CORD COMPRESSION THE CHRISTIE, GREATER MANCHESTER & CHESHIRE. Version:
GUIDELINES FOR RADIOTHERAPY IN SPINAL CORD COMPRESSION THE CHRISTIE, GREATER MANCHESTER & CHESHIRE Procedure Reference: Document Owner: Dr V. Misra Version: Accountable Committee: V4 Acute Oncology Group
More informationRef No: AngCN-SSG-Sa9. H:\Cancer Network\Tumour Site\Sarcoma\Peer Review\Active\AngCN-SSG- Sa9_v2_Anglia_Configuration_Sarcoma_Services.
Anglia Cancer Network Configuration of Sarcoma Services Please note this document has only been partially approved. For further details, approvals and version control please see Document Management Record
More informationThe Walton Centre. NHS Foundation Trust. Patient Information. Stereotactic Radiosurgery
The Walton Centre NHS Foundation Trust Patient Information Stereotactic Radiosurgery Stereotactic Radiosurgery (SRS) is a non-invasive treatment of brain tumours (benign and malignant), arteriovenous malformations
More informationCarbon Ion Radiotherapy for Skull Base and Paracervical Chordomas
Carbon Ion Radiotherapy for Skull Base and Paracervical Chordomas Azusa Hasegawa, Jun-etsu Mizoe and Hirohiko Tsujii Research Center Hospital for Charged Particle Therapy National Institute of Radiological
More informationBladder Cancer Guidelines
Bladder Cancer Guidelines Agreed by Urology CSG: October 2011 Review Date: September 2013 Bladder Cancer 1. Referral Guidelines The following patients should be considered as potentially having bladder
More informationNational Optimal Lung Cancer Pathways. Dr Sadia Anwar Nottingham University Hospitals NHS Trust Clinical Lead for Lung Cancer
National Optimal Lung Cancer Pathways Dr Sadia Anwar ttingham University Hospitals NHS Trust Clinical Lead for Lung Cancer Overview How NOLCP evolved How it relates to national guidance Pathways Implementation
More informationCURRICULUM OUTLINE FOR TRANSITIONING FROM 2-D RT TO 3-D CRT AND IMRT
CURRICULUM OUTLINE FOR TRANSITIONING FROM 2-D RT TO 3-D CRT AND IMRT Purpose The purpose of this curriculum outline is to provide a framework for multidisciplinary training for radiation oncologists, medical
More informationAppendix 4 Urology Care Pathways
Appendix 4 Urology Care Pathways Cancer Care Pathways outline the steps and stages in the patient journey from referral through to diagnostics, staging, treatment, follow up, rehabilitation and if applicable
More informationThere are three referral categories used in the dental referral system:
Restorative Dentistry Referral Criteria Restorative Dentistry referral criteria are outlined to provide General Dental Practitioners (GDPs), Community Dental Service (CDS) Dentists, Primary Care Specialists,
More informationThe objective of this lecture is to integrate our knowledge of the differences between 2D and 3D planning and apply the same to various clinical
The objective of this lecture is to integrate our knowledge of the differences between 2D and 3D planning and apply the same to various clinical sites. The final aim will be to be able to make out these
More information