By Nancy Y. Lee, Jiade J. Lu

This guide will let radiation oncologists to thoroughly and optimistically opt for and delineate tumor volumes/fields for conformal radiation remedy, together with intensity-modulated radiation treatment (IMRT), in sufferers with usually encountered cancers. The orientation of this guide is completely functional, in that the point of interest is at the representation of scientific objective quantity (CTV) delineation for every significant malignancy. each one bankruptcy presents directions and concise wisdom on therapy making plans and CTV choice, explains how the anatomy of lymphatic drainage shapes goal quantity choice, and provides precise illustrations of delineations, slice by means of slice, on making plans CT photographs. whereas the emphasis is heading in the right direction quantity delineation for third-dimensional conformal treatment and IMRT, details can also be supplied on traditional radiation treatment box setup and making plans for yes malignancies for which IMRT isn't at present suitable.

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Y. Lee Fig. 2 CT simulation with 3-mm slices in a head shell was performed in the same patient following superficial parotidectomy with clear margins. These are representative slices and not all slices are included. Of note, the temporal region where the skin cancer originated should also be included using either electrons matching to IMRT or 3D CRT, or an all inclusive IMRT or 3D CRT plan, especially if the primary site treatment was less than a year prior. The structures at the base of skull in the first figure are labelled in Fig.

Y. 2 Suggested target volumes at the high-risk subclinical region Target volumes Definition and description Parotid or submandibular CTV60 should encompass the entire GTV CTV60 or the surgical bed for postoperative patients Landmarks for the parotid surgical bed Anterior: masseter muscle Lateral: soft tissue of neck Medial: styloid process at depth Posterior: mastoid bone Landmarks for the submandibular surgical bed Include the entire surgical bed, all postoperative changes, and use the contralateral submandibular gland as a guide Highly consider a boost of 6–10 Gy to residual disease or positive margins.

Cahlon et al. Tracheostomy site included in CTV60 Fig. 3 (continued) Exclude scale muscles from CTV 4 Hypopharyngeal Carcinoma Gaorav P. Gupta and Nancy Y. Lee General Principles of Planning and Target Delineation • The hypopharynx consists of the pyriform sinuses, posterior pharyngeal wall, and postcricoid region. It has extensive lymphatic drainage to level 2–4 jugulodigastric nodes, retropharyngeal nodes (including the nodes of Rouviere), and for inferior tumors involving the postcricoid region additional drainage to the paratracheal lymph nodes.

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