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Open Access Highly Accessed Case report

Successful treatment of a free-moving abdominal mass with radiation therapy guided by cone-beam computed tomography: a case report

Bouthaina Dabaja1*, Kelly J Perrin1, Jorge E Romaguera2, Patricia Horace1, Christine F Wogan1, Ferial Shihadeh1 and Mohammad R Salehpour3

Author Affiliations

1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA

2 Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA

3 Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA

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Journal of Medical Case Reports 2010, 4:329  doi:10.1186/1752-1947-4-329

Published: 19 October 2010

Abstract

Introduction

Because tumors in the abdomen can change position, targeting these tumors for radiation therapy should be done with caution; use of daily image-guided radiation therapy is advised.

Case presentation

We report the case of a 72-year-old Caucasian man with recurrent mantle cell lymphoma who was referred for palliative radiation therapy for an abdominopelvic tumor. Computed tomography was used to generate images for radiation treatment planning. Comparison of those planning images with a positron emission tomography/computed tomography scan ordered during the planning period revealed that the tumor had moved from one side of the abdomen to the other during the three-day interval between scans. To account for this unusual tumor movement, we obtained a second set of planning computed tomography scans and used a Varian cone-beam computed tomography scanner with on-board imaging capability to target the tumor before each daily treatment session, leading to successful treatment and complete resolution of the mass.

Conclusion

Abdominal masses associated with the mesentery should be considered highly mobile; thus, radiation therapy for such masses should be used with the utmost caution. Modern radiation therapy techniques offer the ability to verify the tumor location in real time and shift the treatment ports accordingly over the course of treatment.