TARGET DELINEATION IN VULVAL CANCER BY DR KANHU

1. ROW CASE - RADIATION ONCOLOGY WORKFLOW
TARGET DELINEATION IN VULVAL CANCER
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Dr Kanhu Charan Patro
MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC
Clinical Director, HOD (Radiation Oncology)
ISRo- Institute of Stereotactic Radiation oncology
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam
drkcpatro@gmail.com /M- +91-9160470564/ www.drkanhupatro.com

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4. Target delineation workflow in CANCER vulva
STEPS GCP EXPLANATION
STEP-1 GTVp Clinicoradiological
STEP-2 CTVp 1cm margin
STEP-3 GTVn Clinicoradiological
STEP-4 CTVn Clinicoradiological + 0.5cm
STEP-5 CTVp ELECTIVE CTVp + Location dependent
STEP-6 CTVn ELECTIVE Common iliac+ Internal iliac+ External Iliac + Presacral + Obturator
STEP-7 OAR As per need
STEP-8 Special editing Barriers and OAR [bone + muscle +air]
STEP-9 PTVn Institutional and technique based
STEP-10 PTVp Institutional and technique based

7. GCP parameter for vulval cancer- confined to vulva
1. Labia majora and minora, clitoris, vestibule, urethral meatus, introitus, perineum
2. The CTV_Vulva also includes the GTV_Vulva +10 mm.
3. Consideration can be given to excluding some areas from this expansion such as the legs or outside the body.
4. 5 mm inside the bone can be included in this expansion, to cover potential periosteal involvement

8. GCP for vulval cancer- involvement of mons pubis
1. Skin bridge between the vulva and inguinal lymph node bilaterally
2. Include whole mons if tumour is involving the mons; also include when treating a primary/postoperative vulval tumour and LN.
3. 5 mm from skin surface if no bolus and to skin surface if bolus
4. It is acceptable not to include the mons in CTV_Vulva if there is a small vulval lesion that lies behind the posterior vaginal wall, even if there are
positive inguinal LN.

9. GCP for vulval cancer- involvement of vagina
At least 3 cm of caudal vagina (with consideration of including the entire vaginal length)

10. GCP for vulval cancer- involvement of ANORECTRUM

11. GCP for vulval cancer- involvement of URETHRA

12. GCP for vulval cancer- Contouring workflow

13. NODAL VOLUME IN VULVAL CANCER

14. RADIATION DOSE IN VULVAL CANCER

15. OAR CONSTRAINTS IN VULVAL CANCER

16. Pelvic nodal borders in target delineation

17. GCP for vulval cancer- involvement of CLITORIS

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