PMC6159199_01
T2 weighted MRI scans at the level of L2. Note the artefact caused by the metal reconstruction, which consists of a central vertebral cage and posterior rods. (a) Pre-radiotherapy (in 2010). A large mass is seen centred on the spine and involving the psoas muscles bilaterally. Tumour involves the body of the vertebra. A separate nodule is seen on the right psoas anteriorly. The whole spinal canal is filled with tumour and the nerve roots cannot be resolved separately. (b) Year 1 post-radiotherapy, (c) Year 3 post- radiotherapy, (d) Year 5 post-radiotherapy. Substantial reduction in the size of the mass, and the lumbar nerve roots can now be seen.
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These tracked down the previous surgical approaches into the psoas muscle (Figure 1a). Follow up-MRI (Figure 1b-d) showed tumour regression, and an un-irradiated satellite lesion was stable, raising the intriguing possibility of an abscopal effect.
A dose distribution of plan in axial (a) and coronal (b) planes. The main planning target volume (PTV) (pale blue) and PTVs for two tumour nodules (dark blue & green) are shown. Within the main PTV, three components of the gross tumour volume are seen (2 blue/purple in a, and pink in b). Contours of both kidneys, liver, large bowel, small bowel, ureters (yellow), and planning organ at risk volumes for both ureters are shown. In (b), the approximate position of the nerve roots below the conus medularis has been contoured in green within the PTV. Lower dose isodoses are turned off for clarity.
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Figure 2 illustrates the dose distribution.