Ms. Evelyn Viola has been a dedicated hospital volunteer for over three decades but earlier this year, to her surprise, she was suddenly a patient herself. She was washing her face when he noticed a large mass at her left neck. Looking in the mirror, the usual angle of her mandible had been replaced by a 5 cm firm mass. Biopsy by an Ear Nose & Throat surgeon revealed she had a CD20+ B-cell lymphoma with a very high Ki67, reflecting a fast growing tumor. CT scans revealed the cancer had not spread beyond her neck and she was scheduled for surgical excision.

Unfortunately, intraoperatively the mass was found to be fibrotic and located deep to her sternocleidomastoid muscle- thus rendering it unresectable. The surgeon closed the neck and referred her to radiation. The tumor was not only large but close to her spinal cord and parotid gland. To avoid these normal organs, a highly customized intensity modulated radiation therapy (IMRT) plan was made to target the tumor while sparing the adjacent healthy tissues. The photos illustrate: a) the IMRT plan with the tumor outlined in red and b) Mr. and Mrs. Viola, cancer-free, with our radiation team. Important advances in lymphoma demonstrate that radiation is not only an effective alternative to surgery but with IMRT, treatment volumes and dose are so modest that many previous side effects are a thing of the past.