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Faculty:Magdalena A-SWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description:A 64-year-old patient diagnosed with induced oligoprogression undergoing chemotherapy in the course of disseminated hepatocellular carcinoma.Current imaging studies (CT of the chest, abdomen, and pelvis, 21.11.2024) revealed: -a lesion in liver segment 7 measuring 115 x 97 mm -a lytic area in the Th8 vertebral body with a soft tissue mass (50 x 40 mm) protruding into the spinal canal, causing spinal cord compression - additionally, metastatic bone lesions were described.Follow-up imaging studies showed stabilization compared to previous scans, with regression of some described lesions compared to the CT from 22.08.2023.The patient underwent palliative radiotherapy to the pubic bone on 24.10.2023. Currently receiving Cabozantinib as part of a Drug Program.Since early December 2024, the patient has experienced progressive lower limb weakness. Palliative radiotherapy was performed in December 2024 to the Th8 region (8.0 Gy/1 fx)At the Oncology Board, was proposed a more radical approach to treating the Th8 vertebra, before the planned neurosurgical procedure, while maintaining systemic therapy with Cabozantinib..Contouring homework: Delineate GTV and CTV using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
Faculty:Magdalena A-SWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description: A 75-year-old patient diagnosed with an L4 spinal metastasis, likely due to disseminated colorectal cancer. Neurologically assessed due to severe radicular pain in the left lower limb, preventing ambulation.MRI of the L-S spine (16.11.2024) showed the L4 vertebral body, including the arch, superior articular process, and transverse process on the left side, displaying an abnormal signal on T2 and STIR sequences, low signal on T1, with features of intense contrast enhancement—suspected tumor (TU susp.). The lesion infiltrates adjacent soft tissues, narrows the left intervertebral foramen at L3-L4 and to a lesser extent at L4-L5, protrudes into the spinal canal, and adheres to the dural sac, causing left-sided compression.CT of the chest, abdomen, and pelvis (14.02.2025) revealed a suspected tumor at L4 with a few round lymph nodes in the surrounding area; otherwise, no significant findings.At the Multidisciplinary Tumor Board, the patient was qualified for nerve decompression and stabilization, followed by radiotherapy. Systemic treatment is planned after completing further diagnostics.On 13.02.2025, the patient underwent left-sided facetectomy and pediculotomy at L3-L4, with removal of tumor masses from the spinal canal and intervertebral foramina at L3-L4, achieving nerve decompression. Percutaneous transpedicular stabilization was performed using carbon screws at L2-L3-L5-S1.Contouring homework: Delineate GTV (+/- CTV if necessary) using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
Faculty:Magdalena A-SWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description: A 69-year-old patient was admitted to the Department of Neuro-Oncology and Radiosurgery for treatment of a metastatic lesion in the spine. His medical history includes radical prostatectomy with lymphadenectomy in 2022.Histopathology: adenocarcinoma, Gleason score 7 (4+3), pT2bN0.He completed conventional radiotherapy by May 2023.Hormonal therapy was continued until October 2023.Follow-up tests showed a gradual increase in PSA levels (1.27 ng/ml on January 27, 2025).The [68Ga]Ga-PSMA11 PET/MR scan suggests a metastatic malignant lesion involving the spinous process of the Th1 vertebra. Based on the decision of the Multidisciplinary Tumor Board, the patient was qualified for stereotactic radiotherapy targeting the metastatic lesion in the Th1 vertebra.Contouring homework: Delineate GTV (+/- CTV if necessary) using planning CT and planning MRI.Additional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
Faculty:TBDWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description:47-year-old female with metastatic BRAF (+) melanoma of the skin (thorax), which has spread to the lungs, liver and bones.Ongoing treatment with nivolumab.Slight increase in lung and liver lesions on CT dated 02.2023. Increasing lytic metastasis in Th1 (thoracic spine) without clear spinal canal involvement: oligoprogression. SINS scale: 5 points.Proposed treatment: SBRT (without surgery) 3x9 GyContouring homework: Delineate GTV and CTV using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
Faculty:TBDWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description:65-year-old man with metastatic colorectal cancer, multiple metastases in the liver, periaortic, possibly in the lungs and bones (metastatic lesion in the Th7 vertebral body protruding into the spinal canal and significantly narrowing its lumen, with filling of the L foramen).Proposed treatment: Separative surgery + postoperative SBRT (SIB 5x6/7 Gy)In 05.2023, the Th5-Th9 spine was stabilised and the tumour was removed at the Th7 level - semi-separative surgery.Pain in the thoracic spine region with radiation to the left ribs has decreased, postoperative pain persists.Contouring homework: Delineate CTV using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
Faculty:TBDWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description:36-year-old female with metastatic breast cancer Left breast cancer cT3N0M0.Status after left mastectomy and reconstruction Status after left axillary lymphadenectomy Status after adjuvant radiotherapy to the left chest wall and lymph nodesStatus after chemotherapy 4xAC+12xPCL/Trastuzumab Status after systemic treatment with adjuvant Trastuzumab until October 2023
MR 07.2024, metastatic lesions of TH9/TH10 with compression of the meningeal sac, narrowing of the foramen intervertebrale
Suggested Treatment: SBRT (3x10 Gy) + spinal surgery
Contouring homework: Delineate CTV using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
