PMC3573796_01
The tumor in the patient's hard palate had a smooth surface. a Before treatment, bleeding from the anterior aspect of the tumor was stopped temporally by local hemostatics using the SurgicelTM Fibrillar Absorbable Hemostat (Ethicon Biosurgery, Inc., Somerville, N.J., USA). b Two years after treatment, the tumor maintained remission.
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F1
When she visited our hospital, she could not speak or chew because of the massive tumor (fig. 1) and was therefore dependent on liquid dietary supplements.
Extensive PLGA originating from the hard palate with left Rouviere's lymph node metastasis (arrow). a Coronal view of the contrast-enhanced T1-weighted MRI before treatment; b coronal view of the contrast-enhanced T1-weighted MRI 2 years after treatment; c axial view of the contrast-enhanced T1-weighted MRI before treatment, and d axial view of the contrast-enhanced T1-weighted MRI 2 years after treatment.
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F2
The MRI also revealed a suspected left Rouviere's lymph node metastatic lesion measuring 2.2 x 2.1 x 1.9 cm (fig. 2).
Proton beam dose distribution: the tumor was treated with 70.4 GyE in 32 fractions. a Coronal view; b axial view, and c sagittal view.
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F3
After transfusion, the superficial temporal arteries (STAs) were cannulated and cisdiamminedichloroplatinum (II) (CDDP) infusion was started concurrently with proton beam therapy (fig. 3). Two portal beams were arranged in the optimal angles to avoid excess-dose exposure to the normal tissues (fig. 3). The dose was calculated based on a pencil beam algorithm.