This is a 54 y/o man with locally advanced nasopharyngeal carcinoma, stage IVA, T4N1M0 who presented with R cervical adenopathy and right CN IX, X, XI, XII palsies with MRI showing disease in the right fossa of Rosenmuller and right skull base including the parapharyngeal space and jugular foramen.
Rx:
Chemotherapy:
Sim/Planning:
Case contributed by UCSD.
Per Lee Radiother Oncol 2018 for CTV delineation in nasopharyngeal carcinoma.
The intermediate risk CTV for a T4 tumor should include:
This patient had right CN IX, X, XI, XII palsies on exam, so these nerves were traced and included in the high dose CTV.
Low risk - Rx with 54 cGy volume includes bilateral IB-V, with IB often omitted in the N0 neck.
For cases of advanced nasopharyngeal carcinoma with cranial nerve deficits on exam, close attention should be paid to nerve tracing of the involved cranial nerves.
To ensure adequate tracing of these pathways back to at least the skull base, it is useful to remember where each cranial nerve leaves the skull:
CT Bone Windows are beneficial in visualizing the foramina, specifically Fromen Rotundum, Froamen Lacerum and Foramen Ovale.
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