By Nancy Y. Lee, Nadeem Riaz, Jiade J. Lu
This textbook is designed to assist the busy radiation oncologist to effectively and hopefully delineate tumor volumes for conformal radiation treatment (including IMRT). The publication offers an atlas of scientific objective volumes (CTVs) for as a rule encountered cancers, with each one bankruptcy illustrating CTV delineation on a slice-by-slice foundation, on making plans CT photographs. universal anatomic editions for every tumor are represented in person illustrations, with annotations highlighting alterations in assurance. The anatomy of every website and styles of lymphatic drainage are mentioned, and their effect at the layout of CTVs is defined intimately. usage of alternative imaging modalities, together with MRI, to delineate volumes is highlighted. Key information of simulation and making plans are in brief reviewed. even if the emphasis is on track quantity delineation for conformal ideas, details is additionally supplied on traditional radiation box setup and layout while IMRT isn't really suitable.
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Extra resources for Target Volume Delineation for Conformal and Intensity-Modulated Radiation Therapy
Sample text
Surgical margins were widely clear. The high-risk CTV (CTV60) is shown in green. Neck nodal levels I–IV are included on the ipsilateral side. The CTV extends cranially to the buccal-gingival sulcus and infratemporal fossa, caudally to the buccal-gingival sulcus and submandibular gland, anteriorly to the lip commissure, and posteriorly to the retromolar trigone. The high-risk CTV should extend superiorly to the inferior orbital rim (not shown). Wide margins should be used, even in the case of small T1 tumors.
Limitations of FDG-PET include poor spatial resolution and low sensitivity for small-volume lymph node metastases. The absence of FDG uptake in an otherwise suspicious lymph node should not be considered reassuring. 3 Simulation and Daily Localization • The patient should be set up in the supine position with the neck extended. The immobilization device (Aquaplast mask) should provide adequate shoulder immobilization. Bite-block and/or mouth guard may be inserted. 5–3 mm slice thickness with IV contrast.
Alternative methods for image guidance include orthogonal kV imaging (“ExacTrac”) or linearaccelerator-mounted MV CT images (“TomoTherapy”). 19 • CTV to PTV expansion of 3–5 mm, depending on the accuracy of daily patient positioning and image guidance. 1 Selected IMRT Dose Fractionation Schemes for Oropharyngeal Cancer • Standard fractionation (33 fractions) with integrated boost. 96 Gy in 33 fractions. 4 Gy in 33 fractions. 12 Gy in 33 fractions. Single phase (simultaneous integrated boost), with 5 fractions weekly (Garden et al.
