By Nancy Y. Lee, Jiade J. Lu
This guide will permit radiation oncologists to adequately and expectantly opt for and delineate tumor volumes/fields for conformal radiation remedy, together with intensity-modulated radiation treatment (IMRT), in sufferers with ordinarily encountered cancers. The orientation of this guide is fullyyt sensible, in that the focal point is at the representation of medical objective quantity (CTV) delineation for every significant malignancy. every one bankruptcy presents directions and concise wisdom on remedy making plans and CTV choice, explains how the anatomy of lymphatic drainage shapes aim quantity choice, and provides specified illustrations of delineations, slice by means of slice, on making plans CT photographs. whereas the emphasis is on track quantity delineation for 3-dimensional conformal remedy and IMRT, info is usually supplied on traditional radiation remedy box setup and making plans for sure malignancies for which IMRT isn't really at present suitable.
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Extra resources for Target Volume Delineation and Field Setup: A Practical Guide for Conformal and Intensity-Modulated Radiation Therapy
Example text
Neck nodal levels I to V are included on the ipsilateral side and levels I to IV are included on the contralateral uninvolved side. Coverage of level V is recommended for oral tongue primaries, especially after surgical manipulation of the neck and ipsilateral nodal disease. (b) Level IA should be covered for oral tongue primaries. (c) The ipsilateral retrostyloid space is at risk for nodal metastasis, especially with level II nodal involvement. Of note, if clinically indicated, can include all anterior fat space.
Additional fractionation regimens as well as cone-down IMRT approaches are also appropriate. We routinely use all-in-one IMRT for hypopharynx cancers, as a match line to a low anterior neck field would frequently fall in the region of the primary tumor or involved lymph nodes. 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.
The patient should be immobilized in the supine position with the neck extended using a thermoplastic mask. 4); and K. D. edu N. D. Y. D. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA A. D. Y. J. 1007/978-3-642-28860-9_5, © Springer-Verlag Berlin Heidelberg 2013 35 36 K. Unger et al. 3) a Subscript numbers represent suggested prescribed doses. 3) a Subscript numbers represent suggested prescribed doses. 1. 2. 3 (Figs. 4). 4 or Tumor site Stage CTV60)a Oral tongue, floor of mouth T1-T4N0 Tumor bed and bilateral levels I–IV at physician’s discretionb Oral tongue, floor of mouth T1-T4N1-3 Tumor bed and ipsilateral levels I–V or bilateral levels I–V if involved contralateral nodesc Buccal mucosa, retromolar trigone, T1-T2N0 Tumor bed and ipsilateral levels I–IV at hard palate, gingiva physician’s discretionb Buccal mucosa, retromolar trigone, T3-T4N0 Tumor bed and ipsilateral levels I–IV hard palate, gingiva Buccal mucosa, retromolar trigone, T1-T4N1-3 Tumor bed and ipsilateral levels I–V or hard palate, gingiva bilateral levels I–V if contralateral involved nodesc 5 Oral Cavity Cancers 37 38 K.
