This is a case of Ca Posterior Pharyngeal wall interstitial brachytherapy performed by me in Aug 2018

1. Posterior Pharyngeal Wall
Brachytherapy
Dr Manish Chandra
Jupiter Hospital, Thane

3. Patient Details
• Age – 47 Yrs
• Sex – Female
• No Comorbidity
• Thin Built with adequate nutrition
• Non-Tobacco user

4. Presenting Complaints
• Presented with pain in throat mainly while swallowing food since 2
months
• Weight Loss – Present
• No cough/bleeding/difficulty in breathing

5. Examination Findings
• Oral Examination: Adequate mouth
opening; good oral hygiene; bilateral
buccal mucosa smooth; tongue mobile &
normal
• Hopkin’s Examination: Fleshy growth
seen in posterior pharyngeal wall starting
from the level of epiglottis & going up to
level of arytenoids but not involving it;
both PFS free; bilateral vocal cords
mobile
• Neck Examination: No lymphadenopathy

6. Relevant Investigations
• Posterior Pharyngeal Wall Biopsy Review (17th May 2018)
Moderately differentiated Squamous cell carcinoma
• CT Neck & Thorax (12th May 2018) Soft tissue lesion noted along
posterior pharyngeal wall from level of C3 to C4 measuring 1.2 x 2.2 x
3.6 cm; No evidence of lymphadenopathy; Pulmonary parenchyma
WNL
• Viral Markers (14th May 2018) Non-Reactive
• S. Creatinine (11th May 2018) 0.9 mg/dl
• CBC (12th May 2018) Hb 13.2 gm%; TLC 6800; DLC P 46 L 39; Plt 2.81

7. Pre- EBRT CT

8. Diagnosis and Plan of Treatment
• Diagnosis - Ca Posterior Pharyngeal Wall cT2 cN0 M0
• Planned - Radiation Therapy to Gross disease with margin delivering
46-50 Gy/ 23-25 fr/5 weeks and rest of Bilateral Neck nodes
delivering 46 Gy/23 fr/5 weeks with concurrent Chemotherapy then
assess with CT neck for brachytherapy
• Delivered 50 Gy/23 fr/ 36 days to gross disease with margin and 46
Gy/ 23 fr/ 36. days to bilateral neck nodes with IMRT , last on 27th Jul

9. Pre and Post EBRT CT Neck

10. Brachytherapy Boost – Implant on 8th Aug 2018

11. Brachytherapy Images

12. Planning – Dose 15 Gy in 5 fr

13. DVH

14. Implant Removal – 10th Aug 2018

15. Trusted team – 10 yrs. and counting……
Left to Right
• Sister Uma
• Ms Rajshee
• Dr R L Bhalavat
• Dr Manish Chandra
• Ms Laxmi Iyer
• Mr Nand Kumar

16. THANK YOU