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Faculty:Magdalena A-SWorkshop Schedule:Polish Society contouring of the Spine March 28-29, 2025Case Description: A 75-year-old patient diagnosed with an L4 spinal metastasis, likely due to disseminated colorectal cancer. Neurologically assessed due to severe radicular pain in the left lower limb, preventing ambulation.MRI of the L-S spine (16.11.2024) showed the L4 vertebral body, including the arch, superior articular process, and transverse process on the left side, displaying an abnormal signal on T2 and STIR sequences, low signal on T1, with features of intense contrast enhancement—suspected tumor (TU susp.). The lesion infiltrates adjacent soft tissues, narrows the left intervertebral foramen at L3-L4 and to a lesser extent at L4-L5, protrudes into the spinal canal, and adheres to the dural sac, causing left-sided compression.CT of the chest, abdomen, and pelvis (14.02.2025) revealed a suspected tumor at L4 with a few round lymph nodes in the surrounding area; otherwise, no significant findings.At the Multidisciplinary Tumor Board, the patient was qualified for nerve decompression and stabilization, followed by radiotherapy. Systemic treatment is planned after completing further diagnostics.On 13.02.2025, the patient underwent left-sided facetectomy and pediculotomy at L3-L4, with removal of tumor masses from the spinal canal and intervertebral foramina at L3-L4, achieving nerve decompression. Percutaneous transpedicular stabilization was performed using carbon screws at L2-L3-L5-S1.Contouring homework: Delineate GTV (+/- CTV if necessary) using planning CT and planning MRIAdditional Resource Files:- EduCase Training Video: How to contour, complete the homework, and save/submit- EduCase User Guide (HTML5 version)- EduCase Metrics Guide (basic)
