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Fig. 1 | Radiation Oncology

Fig. 1

From: The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

Fig. 1

Re-irradiation for a recurrent oropharynx carcinoma in a 79-year-old male patient. The patient received chemoradiotherapy with 70 Gy for a HPV-positive cT4 cN2c cM0 oropharyngeal carcinoma (7th Edition of the UICC TNM classification) between March and May 2010. In July 2017, the patient developed a recurrent HPV-positive rcT2 rcN1 cM0 oropharyngeal carcinoma which was treated by re-irradiation with 52.2 Gy between September and October 2017. Initially, a total re-irradiation dose of 59.4 Gy was planned, but the treatment was discontinued after worsening of the patient’s general condition. Pretherapeutic MRI imaging (a) in July 2017 and FDG-PET-CT imaging (b) in August 2017 showing the recurrent rcT2 rcN1 cM0 oropharyngeal carcinoma on the right side. Based on the recommendations of the multidisciplinary tumor board, re-irradiation using IMRT was performed. Dose distribution of the IMRT plan is shown in an axial (c), coronal (d) and sagittal (e) scan image. PTV1 (pale pink) receiving 50.4 Gy in 28 fractions and PTV2 (pink) receiving 9 Gy in 5 fractions as sequential boost are shown as well as the lines for the 95%-isodose (yellow), 80%-isodose (green), 60%-isodose (cyan) and 20%-isodose (blue). The last MRI in November 2019 (f) showed no signs of recurrence

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