By Nancy Y. Lee, Nadeem Riaz, Jiade J. Lu
This textbook is designed to aid the busy radiation oncologist to competently and with a bit of luck delineate tumor volumes for conformal radiation remedy (including IMRT). The publication offers an atlas of scientific aim volumes (CTVs) for regularly encountered cancers, with every one bankruptcy illustrating CTV delineation on a slice-by-slice foundation, on making plans CT photos. universal anatomic variations for every tumor are represented in person illustrations, with annotations highlighting alterations in assurance. The anatomy of every web site 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 info of simulation and making plans are in brief reviewed. even if the emphasis is on track quantity delineation for conformal options, info can be supplied on traditional radiation box setup and layout whilst IMRT isn't suitable.
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If the tumor is well lateralized, ipsilateral levels I-IV alone can be treated. Otherwise, consider treating bilateral cervical lymph nodes It is important to be generous with target volumes when treating the inner cheek. Include the tumor bed and the entire buccal mucosa. Posteriorly, this should extend to retromolar trigone. Superiorly, this should extend to near the inferior orbital rim. Ipsilateral levels I-IV should be treated within the neck. Depending on pathologic findings and discussions with the surgeon, consideration can be given to treating the contralateral neck as well Include the preoperative tumor volume and postoperative tumor bed.
In cases of gross involvement of the low neck or near the match-line, whole neck IMRT is preferred. 3 J. Setton et al. , base of tongue tumors that are superficial and not apparent GTV70 on imaging) and imaging Neck nodes: all suspicious (>1 cm, necrotic, enhancing, or FDG avid) lymph nodes. Borderline suspicious lymph nodes may be treated to an intermediate dose (66 Gy in 33 fractions) Typically same as GTV70 (no added margin). 4 should encompass GTV + minimum 1 cm margin while respecting anatomical barriers to spread, including bone, air, and skin Neck nodes – should include the at-risk lymphatic areas in the node-positive neck: Levels II–IV Lateral retropharyngeal lymph nodes up to skull base/jugular foramen High level II/retrostyloid space (see Fig.
Bolus is placed on the skin to provide adequate coverage of the high-risk CTV 46 Z. Kohutek et al. Cover CN V2 starting just inferior to optic chiasm CN V2 at foramen rotundum Cover entire hard palate above bite block Fig. 16 A patient with adenoid cystic carcinoma of the right hard palate, pathologic stage T2N0. The patient is status post bilateral partial maxillectomy, with extensive perineural invasion and positive margins. The patient was randomized to treatment with cisplatin-based chemoradiation on protocol RTOG 1008.