Delineation of breast cancer part ii
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This document provides details on contouring and delineating target volumes for breast cancer radiation therapy. It discusses the anatomy and boundaries of lymph node regions in the supraclavicular, axillary, internal mammary, and mediastinal areas. Diagrams show the relationships between surrounding structures like blood vessels, muscles, bones, and organs. Guidelines are provided for accurately defining clinical target volumes on different imaging planes and slices.
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Delineation of breast cancer part ii
- 1. Delineation in Breast Cancer (Part II) Mohammed Fathy Bayomy, MSc, MD Lecturer Clinical Oncology & Nuclear Medicine Faculty of Medicine Zagazig University
- 3. 1999
- 6. Internal Jugular Vein Common Carotid Artery Sternocleidomastoid Thyroid gland Clavicle Anterior scalene Posterior scalene Serratus anterior Longus coli muscles External Jugular Vein Scapula 1st thoracic vertebrae 1st rib Levator scapulae muscle Subscapularis Trapezius Rhomboids major Middle scalene
- 8. Clavicle Rib Sternocleidomastoid Internal Jugular Vein Common Carotid Artery Subclavian Vein Subclavian artery Pectoralis major Clavicle Acromian Glenoid Head of Humerous
- 27. 2000
- 28. CT anatomy of target volume • Upper end: supraclavicular region • Lower end: 1-1.5 cm below breast • Upper part of the volume: lymphatics of supraclavicular and apex axilla lymph nodes • Middle & lower part of the volume: lymphatic level I & II of axillary nodes + internal mammary nodes + breast (post conservative surgery &/or chest wall (post-MRM)
- 29. 2001
- 30. SCV fossa • Lesser SCV fossa: depression between two heads of sternocleidomastoid muscle. • Greater SCV fossa: at base of posterior triangle of neck = omoclavicular triangle Subdivided into two compartments
- 31. • Medial: extend to lateral edge of trachea, excluding thyroid gland and thyroid cartilage. • Anterior: deep surface of sternocleidomastoid muscle & deep cervical fascia. • Posterolateral (cranial): anterior & medial borders of anterior scalene muscle. • Posteromedial (cranial): extend medially to carotid artery & internal jugular vein. • Posterior (caudal): subclavian artery.
- 33. Sternocleidomastoid muscle Anterior Scalene muscle Internal jugular vein Common carotid artery Thyroid cartilage Cricoid cartilage Hypopharynx
- 35. Sternocleidomastoid muscle Anterior Scalene muscle Cricoid cartilage Thyroid cartilage Internal jugular vein Common carotid artery Thyroid gland Hypopharynx
- 37. Sternocleidomastoid muscle Anterior Scalene muscle Common carotid artery Cricoid cartilage Thyroid gland Thyroid cartilage Internal jugular vein Esophagus Clavicle
- 39. Thyroid gland Common carotid artery Anterior Scalene muscle Clavicle Internal jugular vein Sternocleidomastoid muscle Esophagus Trachea
- 41. Thyroid gland Internal jugular vein Esophagus Trachea Anterior Scalene muscle Common carotid artery Sternocleidomastoid muscle Clavicle
- 43. Common carotid artery Internal jugular vein Trachea Thyroid gland Esophagus Subclavian artery Sternocleidomastoid muscle Clavicle Anterior Scalene muscle
- 45. Common carotid artery Thyroid gland Internal jugular vein Anterior Scalene muscle Clavicle Sternocleidomastoid muscle Subclavian artery Esophagus Trachea
- 47. Common carotid artery Internal jugular vein Clavicle Sternocleidomastoid muscle Subclavian artery Esophagus Trachea
- 49. Common carotid artery Internal jugular vein Clavicle Sternocleidomastoid muscle Subclavian artery Esophagus Trachea
- 51. Common carotid artery Brachiocephalic vein Clavicle Sternocleidomastoid muscle Subclavian artery Esophagus Trachea
- 52. ICV fossa • Superior : pectoralis minor muscle • Inferior : level of insertion of clavicle into manubrium. • Lateral : medial border of pectoralis minor muscle. • Medial : lateral edge of clavicle. • Anterior : deep surface of pectoralis major. • Posterior : subclavian & axillary artery.
- 57. 2004
- 59. 2004
- 60. P A LAp
- 79. 2010
- 82. 2010
- 90. Cranial Sternum 2nd rib Clinical reference Insertion 2nd rib Cranial Caudal Cranial Caudal LateralMedial Medial Lateral Anterior Posterior AnteriorPosterior Sagittal Coronal Axial X
- 91. Caudal Loss of apparent breast Clinical referenceClinical reference CranialCranial CaudalCaudal Anterior AnteriorPosterior Posterior LateralMedial LateralMedial CoronalSagittal Axial X
- 92. Anterior Skin Skin Anterior Posterior LateralMedial Cranial AnteriorPosterior Caudal Axial Sagittal
- 93. Posterior Pectoralis muscles Ribs Exclude Intercostal muscles Exclude Serratus anterior muscle Ribs Axial Sagittal Posterior Anterior LateralMedial Posterior Anterior Anterior Posterior Cranial Caudal Exclude Pectoralis muscles Intercostal muscles Ribs Exclude
- 101. Cranial Sternum Caudal end ClavicleClavicleClavicle Sternum Clavicle Axial Sagittal Coronal Cranial Caudal Caudal Cranial LateralMedial Anterior Posterior AnteriorPosterior Clavicle LateralMedial Cranial Caudal
- 103. Anterior Skin Skin Anterior Posterior LateralMedial Cranial AnteriorPosterior Caudal Axial Sagittal
- 104. Posterior Skin Anterior Posterior Lateral Medial Cranial AnteriorPosterior Caudal Axial Sagittal Rib-pleural interface Rib-pleural interface Serratus anterior muscle Intercostal muscles Ribs Pectoralis muscles Serratus anterior muscle Include Include Include
- 107. Breast + Chest wall CTV
- 114. Cranial Sternum Caudal end Clavicle Clavicle Clavicle Axial Sagittal Coronal Cranial Caudal Caudal Cranial Lateral Medial Anterior Posterior AnteriorPosterior Lateral Medial Cranial Caudal
- 115. Caudal Loss of apparent breast Clinical reference Clinical reference CranialCranial CaudalCaudal Anterior AnteriorPosterior Posterior Lateral Medial Lateral Medial CoronalSagittal Axial
- 116. Anterior Skin Skin Anterior Posterior Lateral Medial Cranial AnteriorPosterior Caudal Axial Sagittal
- 117. Posterior Skin Anterior Posterior Lateral Medial Cranial AnteriorPosterior Caudal Axial Sagittal Rib-pleural interface Rib-pleural interface Serratus anterior muscle Intercostal musclesRibs Pectoralis muscles Include Include Anterior Posterior Medial Anterior Posterior Lateral Medial Anterior Posterior
- 118. Lateral Exclude Latissimus dorsi Clinical reference Axial Latissimus dorsi Exclude Sagittal Posterior Anterior Anterior Cranial Caudal Lateral Medial Posterior Anterior Cranial Caudal
- 121. Level ILevel I
- 122. Cranial Lateral edge Pectoralis minor Axillary vessels Axillary vessels Axillary vessels Pectoralis minor Axillary vessels Axial Sagittal Coronal LateralMedial Anterior Posterior Cranial Caudal Cranial Caudal Anterior Posterior Medial Lateral Cranial Caudal
- 123. Caudal Pectoralis major ??? Axial Anterior Posterior Medial Lateral
- 124. Anterior Pectoralis major Latissimus dorsi Plane Axial Medial Lateral Latissimus dorsi Pectoralis major Plane Anterior Posterior
- 129. Cranial Pectoralis minor Axillary vessels Medial edge Axillary vessels Pectoralis minor Axillary vessels CoronalSagittal Axial Cranial Caudal Caudal Cranial Lateral Medial AnteriorPosterior Posterior Anterior
- 130. Caudal Lateral edge Pectoralis minor Axillary vessels Pectoralis minor Axillary vessels Axial Sagittal Coronal LateralMedial Anterior Posterior Cranial Caudal Cranial Caudal Anterior Posterior Medial Lateral
- 131. Anterior Pectoralis minor Ant. surface Ant. surface Pectoralis minor Sagittal Axial Anterior Posterior Anterior Posterior Lateral Medial Cranial Caudal
- 135. Level IIILevel III
- 137. Caudal Pectoralis minor Axillary vessels Medial edge Axillary vessels Pectoralis minor Axillary vessels CoronalSagittal Axial Cranial Caudal Caudal Cranial Lateral Medial AnteriorPosterior Posterior Anterior Medial Lateral
- 138. Anterior Sagittal Pectoralis major Posterior surface AnteriorPosterior Cranial Caudal Posterior Anterior Lateral Medial Pectoralis major Posterior surface Axial
- 143. Cranial Cricoid cartilage Lateral Axial Coronal Medial Cranial Caudal Cricoid cartilage Anterior Posterior Lateral Medial Caudal end Caudal end Sagittal Caudal Cranial AnteriorPosterior
- 144. Caudal Junction Clavicle Caudal edge Internal jugular vein Subclavian vein Internal jugular vein Axillary vein Brachiocephalic vein Coronal Cranial Caudal MedialLateral Axial Anterior Posterior LateralMedial Sagittal Cranial Caudal Anterior Posterior
- 145. Anterior Sternocleidomastoid Sagittal Sternocleidomastoid Axial LateralMedial Lateral Medial Anterior Posterior Anterior Posterior Posterior surface Posterior surface Cranial AnteriorPosterior Caudal
- 146. Posterior Scalene muscle Anterior surface Anterior surface Scalene muscle Axial Anterior Posterior LateralMedial Sagittal Cranial Caudal AnteriorPosterior
- 147. Lateral Sternocleidomastoid Sternocleidomastoid Lateral edge Lateral edge Clavicle 1st rib Junction Coronal Cranial Caudal Medial Lateral Medial Lateral Anterior Posterior Axial
- 152. Caudal Sternum 3rd intercostal space 4th rib Cranial Caudal Posterior Anterior Lateral Medial Medial Lateral Cranial Caudal Anterior Posterior Axial SagittalCoronal
- 153. 2013
- 154. Supraclavicular lymph node • Superior: begin at inferior border of cricoid cartilage. • Inferior: extend to cranial border of clavicular head. • Anterior: sternocleidomastoid muscle (cranial), clavicle (caudal). • Anterolateral: lateral edge of sternocleidomastoid (cranial), lateral border of clavicle (caudal). • Posterolateral: anterior scalene muscle. • Posteromedial: medial to carotid artery & internal jugular vein.
- 155. Infraclavicular lymph node • Superior: superior border of pectoralis minor muscle. • Inferior: superior border of sternum. • Anterior: pectoralis major muscle. • Posterior: ribs & intercostal muscles. • Lateral: medial border of pectoralis minor muscle. • Medial: lateral edge of clavicle
- 157. Common Carotid Artery (CCA) Internal Jugular Vein (IJV) Middle & Posterior Scalene muscles Thyroid gland Sixth Cervical Vertebrae (C6) Esophagus Levator Scapulae muscle Axial Anterior Posterior Medial Lateral
- 159. Left Common Carotid Artery (CCA) Left Internal Jugular Vein (IJV) Middle & Posterior Scalene muscles Thyroid gland Trachea Esophagus Clavicle Coracoid process of scapula First Rib First Thoracic Vertebrae (D1) Axial Anterior Posterior Lateral
- 161. Left Common Carotid Artery (CCA) Trachea Esophagus Clavicle First Rib Second Rib Third Rib Sternothyroid & Sternohyoid muscle Apex of lung Second Thoracic Vertebrae (D2) Scapula Head of Humerous Pectoralis major Serratus anterior muscle Spine of Scapula Supraspinatus muscle Subscapularis muscleIntercostal muscle Subclavius muscle Left Subclavian vein Left Subclavian artery Left Internal Jugular Vein (IJV) Anterior Posterior Medial Lateral
- 163. Pectoralis major SSN Subscapularis muscle Scapula Spine of Scapula Supraspinatus muscle Serratus anterior muscle Clavicle Left Axillary artery Left Axillary vein Left Subclavian artery Left Common Carotid Artery (CCA) Left Brachiocephalic vein Trachea Esophagus First Rib Second Rib Third Rib Fourth Rib (head) Third Thoracic Vertebrae (D3) Infraspinatus muscle Axial Anterior Posterior Medial Lateral
- 165. Clavicle Pectoralis major Left Subclavian artery Left Common Carotid Artery (CCA) Esophagus Trachea Left Brachiocephalic vein First Rib Fourth Rib Third Rib Second Rib Serratus anterior muscle Infraspinatus muscle Subscapularis muscle Scapula Axial Anterior Posterior Medial Lateral
- 166. 2013
- 167. Breast (Post lumpectomy) • Breast CTV: include all mammary glandular tissue. • Lateral border: difficult to define especially with gland involution, lateral thoracic vessel with lateral mammary braches may be used as surrogate marker. • Cranial border: difficult to define especially with gland involution, inferior edge of clavicle may be used as surrogate marker. • Medial border: difficult to define especially with gland involution, lateral edge of sternum may be used as surrogate marker.
- 171. Skin 5mm below Skin 5mm below Skin 5mm below
- 175. Tumor Bed (Boost) • CTV boost: tumor bed (GTV) + 5mm in all direction without exceeding CTV breast • Tumor bed: include all surgically inserted clips, solid tissue and/or seroma in-between. • Data come from: preoperative mammography, mammosonography, MR mammography, operative data. • Surgical clips: surgeons insert 4-6 clips in post-lumpectomy cavity. • Oncoplastic surgery: clips is inserted before transposition & be aware of possible movement of clips.
- 178. Chest wall (postmastectomy) • CTV chest wall: guided by position of contralateral breast. • Borders & MRM scar: marked with radioopaque wires. • MRM scar: cover only part with breast region. • Caudal border: 3 cm caudal to MRM scar (bilateral MRM) • Ventral border: 5 mm below skin except 3cm above to 3cm below scar >>> 3-6 mm bolus is applied • Dorsal border: ventral side of pectoralis major or ribs if difficult to see it
- 183. Skin 5mm below
- 184. Latissmus dorsi muscle Axillary vessels 5mm dorsal
- 185. Skin 5mm below
- 186. CTV breast Lateral border Pectoralis minor muscle
- 188. Axillary vessels 5 mm cranial Axillary vessels 5 mm cranial Axillary vessels 5 mm cranial
- 191. Chest wall Axillary vessels 5 mm dorsal
- 202. Axillary vessels 5 mm cranial
- 203. Axillary vessels 5 mm caudal
- 205. Axillary vessels 5mm dorsal Chest wall Subclavian vessels 5mm dorsal
- 207. Clavicle
- 209. Level III Level II Sternoclavicular junction Cranial border Cranial edge
- 211. Pectoralis major muscle Medial edge Omohyoid muscle Coracobrachialis muscle Coracoid process
- 214. Pleura
- 215. Internal mammary vessels 5mm lateral Sternum 2cm form edge
- 216. Sternum Edge