Skip to main content
SpringerLink
Log in

Lipiodol injections for optimization of target volume delineation in a patient with a second tumor of the oropharynx

A case report

Lipiodolinjektion zur Optimierung der Zielvolumenbestimmung bei einem Patienten mit einem Zweitkarzinom im Oropharynx

Ein Fallbericht

  • Case Study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Lipiodol injections were administered in the head and neck area to improve gross tumor volume (GTV) definition for small-volume re-irradiation of a 63-year-old previously irradiated patient with a second tumor of the oropharynx in the posterior wall with longitudinal ligament infiltration (cT4cN0cM0).

Methods

The patient had dialysis-depending renal failure. On diagnostic computed tomography (CT), which was performed with intravenous contrast agent, the tumor in the oropharynx was not detectable. Because of dialysis-depending renal failure comorbidity, no contrast agent was applied in the planning CT and in the diagnostic magnetic resonance imaging (MRI) study. In each cross-sectional imaging study performed, the GTV, especially in craniocaudal extensions, was not safely delineable. Therefore, craniocaudal tumor margins were pharyngoscopically marked with Lipiodol injections, an iodine-containing contrast agent.

Results

In a second planning CT, the GTV could be defined with the help of the Lipiodol marks and small-volume re-irradiation was performed. No Lipiodol-associated side effects occurred in the patient.

Conclusion

In the present case, the use of Lipiodol injections at the tumor margins facilitated the definition of the GTV.

Zusammenfassung

Ziel

Anwendung von Lipiodolinjektionen im Kopf-Hals-Bereich zur Verbesserung der GTV-Definition bei einer kleinvolumigen Re-Bestrahlung eines 63-jährigen, vorbestrahlten Patienten mit einem Zweitmalignom im Oropharynx mit Infiltration des hinteren Längsbandes (cT4cN0cM0).

Methoden

Nebenbefundlich bestand bei dem Patienten eine dialysepflichtige Niereninsuffizienz. Im initialen diagnostischen Kontrastmittel-CT der Hals und Thoraxregion war der Tumor nicht abgrenzbar, so dass das Bestrahlungsplanungs-CT in Anbetracht des diagnostischen CTs und der bekannten Niereninsuffizienz ohne intravenöses Kontrastmittel durchgeführt wurde. Das diagnostische MRT (vgl. Abb. 1) wurde ebenfalls ohne intravenöses Kontrastmittel durchgeführt wurden. In allen durchgeführten Schnittbildgebungen konnte der Tumor v. a. in kraniokaudaler Ausdehnung nicht sicher abgegrenzt werden. Die kranialen und kaudalen Tumorränder wurden pharyngoskopisch mit Lipiodol, einem jodhaltigem Kontrastmittel, markiert (vgl. Abb 3).

Ergebnis

In einem zweiten Planungs-CT konnte das GTV mit Hilfe der Lipiodolmarkierung abgegrenzt (vgl. Abb. 4) und die kleinvolumige Re-Bestrahlung (vgl. Abb. 5) durchgeführt werden. Es traten keine Lipiodol-assoziierten Nebenwirkungen auf.

Zusammenfassung

In diesem Fall konnte die Markierung der Tumorränder mit Lipiodol die GTV-Definition erleichtern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Basile A, Carrafiello G, Ierardi AM, Tsetis D, Brountzos E (2012) Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol 35:765–774. doi:10.1007/s00270-012-0423-z

    Article  PubMed  Google Scholar 

  2. Bhide SA, Newbold KL, Harrington KJ, Nutting CM (2012) Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers. Br J Radiol 85:487–494. doi:10.1259/bjr/85942136

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Chen AM, Yu Y, Daly ME, Farwell DG, S HB, Purdy JA (2013) Long-term experience with reduced planning target volume margins and intensity-modulated radiotherapy with daily image-guidance for head and neck cancer. Head Neck. doi:10.1002/hed.23532

  4. Lambrecht M, Nevens D, Nuyts S (2013) Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer. Strahlenther Onkol 189:223–229. doi:10.1007/s00066-012-0289-7

    Article  CAS  PubMed  Google Scholar 

  5. Modesto A, Laprie A, Vieillevigne L, Graff P, Sarini J, Vergez S, Delord JP, Farenc JC, Vigarios E, Filleron T, Rives M (2014) Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer: minimization of late dysphagia without jeopardizing tumor control. Strahlenther Onkol. doi:10.1007/s00066-014-0767-1

  6. Patel A, Khalsa B, Lord B, Sandrasegaran K, Lall C (2013) Planting the seeds of success: CT-guided gold seed fiducial marker placement to guide robotic radiosurgery. J Med Imaging Radiat Oncol 57:207–211. doi:10.1111/j.1754-9485.2012.02445.x

    Article  PubMed  Google Scholar 

  7. Pos F, Bex A, Dees-Ribbers HM, Betgen A, van Herk M, Remeijer P (2009) Lipiodol injection for target volume delineation and image guidance during radiotherapy for bladder cancer. Radiother Oncol 93:364–367. doi:10.1016/j.radonc.2009.09.003

    Article  CAS  PubMed  Google Scholar 

  8. Chai X, van Herk M, van de Kamer JB, Remeijer P, Bex A, Betgen A, De Reijke TM, Hulshof MC, Pos FJ, Bel A (2010) Behavior of lipiodol markers during image guided radiotherapy of bladder cancer. Int J Radiat Oncol Biol Phys 77:309–314. doi:10.1016/j.ijrobp.2009.08.019

    Article  CAS  PubMed  Google Scholar 

  9. Sondergaard J, Olsen KO, Muren LP, Elstrom UV, Grau C, Hoyer M (2010) A study of image-guided radiotherapy of bladder cancer based on lipiodol injection in the bladder wall. Acta Oncologica 49:1109–1115. doi:10.3109/02841861003789491

    Article  PubMed  Google Scholar 

  10. Meijer GJ, van der Toorn PP, Bal M, Schuring D, Weterings J, de Wildt M (2012) High precision bladder cancer irradiation by integrating a library planning procedure of 6 prospectively generated SIB IMRT plans with image guidance using lipiodol markers. Radiother Oncol 105:174–179. doi:10.1016/j.radonc.2012.08.011

    Article  PubMed  Google Scholar 

  11. Baumgarten AS, Emtage JB, Wilder RB, Biagioli MC, Gupta S, Spiess PE (2014) Intravesical lipiodol injection technique for image-guided radiation therapy for bladder cancer. Urology. doi:10.1016/j.urology.2013.09.058

  12. Wolff HA, Wolff CR, Hess CF, Jung K, Sennhenn-Kirchner S, Hinterthaner M, Muller-Dornieden A, Korber W, Marten-Engelke K, Roedel R, Christiansen H, Engelke C (2013) Second primary malignancies in head and neck cancer patients: high prevalence of curable-stage disease. Strahlenther Onkol 189:874–880. doi:10.1007/s00066-013-0404-4

    Article  CAS  PubMed  Google Scholar 

  13. Milanovic D, Jeremic B, Grosu AL, Rucker G, Henke M (2013) Reirradiation plus EGFR inhibition in locally recurrent and unresectable head and neck cancer: final results from a single institution. Strahlenther Onkol 189:842–848. doi:10.1007/s00066-013-0402-6

    Article  CAS  PubMed  Google Scholar 

  14. Cacicedo J, Navarro A, Alongi F, Gomez de Iturriaga A, Del Hoyo O, Boveda E, Casquero F, Perez JF, Bilbao P (2014) The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach. Cancer Treat Rev 40:178–189. doi:10.1016/j.ctrv.2013.08.002

    Article  PubMed  Google Scholar 

  15. Becker S, Walter S, Witzke O, Wilde B, Hillen U, Napieralski D, Kreuter A, Altmeyer P, Schieren G, Daul A, Rump LC, Kribben A (2010) The German registry for nephrogenic systemic fibrosis: findings from 23 patients. Clinical Nephrol 73:426–430

    Article  CAS  Google Scholar 

  16. Elmholdt TR, Pedersen M, Jorgensen B, Sondergaard K, Jensen JD, Ramsing M, Olesen AB (2011) Nephrogenic systemic fibrosis is found only among gadolinium-exposed patients with renal insufficiency: a case-control study from Denmark. Br J Dermatol 165:828–836. doi:10.1111/j.1365–2133.2011.10465.x

    Article  CAS  PubMed  Google Scholar 

  17. Amet S, Launay-Vacher V, Clement O, Frances C, Tricotel A, Stengel B, Gauvrit JY, Grenier N, Reinhardt G, Janus N, Choukroun G, Laville M, Deray G (2014) Incidence of nephrogenic systemic fibrosis in patients undergoing dialysis after contrast-enhanced magnetic resonance imaging with gadolinium-based contrast agents: the prospective fibrose nephrogenique systemique study. Invest Radiol 49:109–115. doi:10.1097/RLI.0000000000000000

    Article  CAS  PubMed  Google Scholar 

  18. Hamming-Vrieze O, van Kranen SR, van Beek S, Heemsbergen W, van Herk M, van den Brekel MW, Sonke JJ, Rasch CR (2012) Evaluation of tumor shape variability in head-and-neck cancer patients over the course of radiation therapy using implanted gold markers. Int J Radiat Oncol Biol Phys 84:e201–e207. doi:10.1016/j.ijrobp.2012.03.014

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Hospitals of Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany

    Marlen Haderlein, Ricarda Merten, Andrea Stojanovic, Stefan Speer, Rainer Fietkau & Oliver J. Ott

  2. Department of Otorhinolaryngology, University Hospitals of Erlangen, Erlangen, Germany

    Claudia Scherl

Authors
  1. Marlen Haderlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricarda Merten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Stojanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Speer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Scherl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rainer Fietkau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver J. Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marlen Haderlein.

Ethics declarations

Conflict of interest

M. Haderlein, R. Merten, A. Stojanovic, S. Speer, C. Scherl, R. Fietkau, and O.J. Ott state that there are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haderlein, M., Merten, R., Stojanovic, A. et al. Lipiodol injections for optimization of target volume delineation in a patient with a second tumor of the oropharynx. Strahlenther Onkol 191, 681–686 (2015). https://doi.org/10.1007/s00066-015-0856-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-015-0856-9

Keywords

Schlüsselwörter

Search

Navigation