By Nancy Y. Lee, Jiade J. Lu
This guide will allow radiation oncologists to properly and expectantly decide on and delineate tumor volumes/fields for conformal radiation treatment, together with intensity-modulated radiation treatment (IMRT), in sufferers with in most cases encountered cancers. The orientation of this guide is solely useful, in that the focal point is at the representation of scientific aim quantity (CTV) delineation for every significant malignancy. each one bankruptcy offers instructions and concise wisdom on therapy making plans and CTV choice, explains how the anatomy of lymphatic drainage shapes goal quantity choice, and offers special illustrations of delineations, slice by way of slice, on making plans CT photographs. whereas the emphasis is on track quantity delineation for 3-dimensional conformal remedy and IMRT, details can be supplied on traditional radiation treatment box setup and making plans for yes malignancies for which IMRT isn't really at the moment suitable.
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Sample text
The simulation scan should extend from the top of the skull to the carina. MRI may better delineate primary tumor borders, inform regarding potential cartilage or esophageal invasion, and may also facilitate identification of abnormally enhancing lymph nodes [1–4]. FDG-PET provides metabolic information and may identify hypermetabolic cancer cells within morphologically normal-appearing lymph nodes [5, 6], which should be included within the high-dose PTV. • The patient should be immobilized with a 5-point thermoplastic head and neck mask or with a 3-point thermoplastic head and neck mask and a shoulder pull board.
3), are described in the following tables. The principles of target delineation are similar for early and advanced stages (Figs. 2). , £1 cm), a lower dose of 66 Gy may be considered CTV70 + 10 mm for the primary tumor, depending on PTV70* comfort level of daily patient positioning. Hypopharynx structures are highly mobile, so we do not recommend smaller PTV margins. 5 should encompass the entire CTV70 with at least 1-cm margin, and should include the entire subsite of the involved hypopharynx as well as adjacent superior and inferior structures.
Org R. Y. J. 1007/978-3-642-28860-9_6, © Springer-Verlag Berlin Heidelberg 2013 45 46 D. Spratt et al. 1 Suggested target volumes for gross disease Target volumes Definition and description All gross disease on physical examination and imaging (CT GTV70 and MRI). PET can help further define the tumor extent Usually same as GTV70. 2 Suggested target volumes at the high- and low-risk subclinical regions Definition and description Target volumes Ethmoid Maxillary Tumor implantation area or microscopically affected margins CTV66 The CTV60 should encompass the areas at high risk of microscopic tumor CTV60 spread from initial macroscopic tumor.
