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Submitted Case

2022
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Patient Information: (Do not provide name of the patient)
Age
  QUESTION IS: MANAGEMENT OF COMPLICATIONS (OSTEORADIONECROSIS). Pt is an edentulous 51M KPS 90 w/ extensive Hx of tobacco and EtOH consumption, as well as long-standing depression and anxiety,
Diagnosis
  p/w oral pain for 1-2 years, which then became unbearable and resulted in significant weight loss; ultimately was diagnosed with at stage cT2N2bM0, moderately-differentiated and p16-negative SCC of the left tonsil (overall IVA).
Pathology
  Non-HPV-driven
Overall Oncology Management Plan
Chemotherapy (if given, what is the regimen)
  He completed a course of definitive chemoradiation 10 months ago (high-dose cisplatin 100 mg/m^2 q3 wks)
Radiation Therapy (fields, dose)
  Gross: 70 Gy in 35 fractions, to the high-risk (ipsilateral) nodal areas to the dose of 63 Gy in 35 fractions, and to the low-risk areas (contralateral neck) to a total dose of 56 Gy in 35-Gy fractions, as concomitant integrated boost, given 5/3/2021 – 6/21/2021 with VMAT photons, daily CBCT
Radiation Treatment Plan
Treatment fields review
  see pix
Normal Tissue Sparing
  Pt recovered well after chemoRT, re-gained a bit of weight. In the past two months, however, he started experiencing severe pain "in the left tongue". Lost insurance, was seen after some delay. On exam, there is a sharp ridge of exposed bone left inner mandible, with associated tongue abrasions. No evidence of recurrence on exam or PET. Pt referred to hyperbaric oxygen therapy; went to the dentist who excised the exposed area and sent it for path (still pending)
Images
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Session Name
  Dr. David Sher, Head and Neck Ca., March 28, 2022
Session ID
  11403
created_by
  7717
post_id
  11403
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