Journal Reading

9 February 2016

Presentan : drg. R. Hari Triwijaya

Pembimbing : dr. Nana Supriana, Sp.Rad.(K)Onk.Rad.

Introduction

Radioresponsive?

Radioresistant?

Introduction

Case report
Patient :
Sex : Male
Age : 64 yo

October 2003

Referred to Head and Neck Cancer Clinic.

Chief complaints: gradually increasing painless swelling in the right side of face for
the past 8 years.

Case report
Physical examination:
A huge firm to hard growth on right side of the upper and lower
alveolus.
A firm to hard growth was present in the right infratemporal fossa.
No significant lymphadenopathy was found in the cervical and
clavicular area.
All the baseline investigations : complete hemogram, liver function
test, renal function test, X-ray chest and USG abdomen within
normal limits.

Case report
A contrast enhanced CT scan face:
A big soft tissue mass on right side of the neck and face with
distorted normal anatomy (Fig. 1).
The mass was invading the oral cavity, buccal mucosa and pressing
over the oropharynx.
The mass was also invading the right infratemporal fossa.
There was a central area of necrosis with patchy contrast
enhancement seen.

Case report

Case report
Histopathological examination:
Dense cluster of pleomorphic tumor cells with big hyperchromatic
nuclei (Fig. 2).
There were clusters of tumor cells with large oval to roundish nuclei
with ill-defined pink cytoplasm and dispersed chromatin
ameloblastoma.

Case report

Case report

Case report

Theratron
780C Machine
shielding
eye and brain

60 Gy

30 Fractions
using 2 Gy
fraction

5 days a week
parallel and
oppsed lateral
field

Case report

The latest CECT

(June 2005) and
a KPS of 100 (Fig
3)

discussion
Recognized by
Cusack (1827)

Introduce by
Malassez (1885)

Adamantinoma

Describe later by
Falksson

Ameloblastoma
(Ivey and Churchill, 1930)

discussion
Slow
growing

Locally
invasive
tumors

Ameloblastoma

High rate
of
recurrence

TREATMENT

discussion

Surgical
Radiotherapy
Combination

discussion

Gardner and Pecak :

- Ameloblastoma is radioresistant
- Consequently radiotherapy should not be
used in its treatment

1921 - 1951

Sehdev, et al. :
11 patients 3 patients had persistent
disease and 6 patients had an initial response
followed by later recurrence

1980

discussion

Atkinson et al. :
10 case of ameloblastoma treated by
megavoltage radiotherapy 7 patients with
primary irradiation only and 3 patients with
booth (irradiation and surgery)
ameloblastomas are radioresponsive

1982

Reynolds and Pacyniak :

Radiotherapy had a possible role in the
treatment of those patients who were poor
surgical risk, or were unwilling to accept
extensive surgical procedures.

1984

discussion
Here present case advanced
ameloblastoma responding well to
radiation therapy.

Ameloblastoma is not inherently

radioresistant tumor.
Properly applied megavoltage
radiation techniques have a useful
role in management of these tumors.

conclusion
These case further highlights the role
radiotherapy in advanced, inoperable
ameloblastoma of jaw as a definitive
therapeutic options.

Inoperable ameloblastoma be subjected to

definitive megavoltage radiation therapy to
define the role of radiotherapy in this tumor.

Thank you