TARGET DELINEATION IN CERVIX CANCER BY DR KANHU
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TARGET DELINEATION IN CERVIX CANCER BY DR KANHU
![Target delineation workflow in CANCER CERVIX
DR KANHU CHARAN PATRO
STEPS GCP EXPLANATION
STEP-1 GTVp Clinicoradiological
STEP-2 CTVp Cervix
STEP-3 GTVn Clinicoradiological
STEP-4 CTVn Clinicoradiological + 0.5cm
STEP-5 CTVp ELECTIVE Uterus + Adnexa + Vagina
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
5th MARCH 2024/ TARGET](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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TARGET DELINEATION IN CERVIX CANCER BY DR KANHU
- 1. Target delineation in cervical cancer 3/16/2024 1 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
- 2. Target delineation workflow in CANCER CERVIX DR KANHU CHARAN PATRO STEPS GCP EXPLANATION STEP-1 GTVp Clinicoradiological STEP-2 CTVp Cervix STEP-3 GTVn Clinicoradiological STEP-4 CTVn Clinicoradiological + 0.5cm STEP-5 CTVp ELECTIVE Uterus + Adnexa + Vagina 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 5th MARCH 2024/ TARGET
- 7. CTV_n HR GTV_n + 0.5cm 3/16/2024 7
- 9. CTV NODE COMMON ILIAC 3/16/2024 9
- 10. CTV NODE ILIAC 3/16/2024 10
- 11. CTV NODE GUTTER – CORONAL 3/16/2024 11
- 12. CTV NODE OBTURATOR 3/16/2024 12
- 15. What is PARAMETRIUM? 1. The fat and connective tissue that surrounds the uterus. 2. The parametrium helps connect the uterus to other tissues in the pelvis.
- 16. PARAMETRIUM content? 1. The parametrium includes the superficial uterine pedicle (uterine artery and superficial uterine vein) and related connective tissue and lymphatic channels. 2. The connective tissue crossing below the ureter is considered paracervix.
- 17. GUIDELINE
- 18. CTV CERVIX
- 19. PARAMETRIUM
- 20. BOUNDARY
- 21. BOUNDARY 1. Superior boundaries of the parametria are at the top of the fallopian tube, and contours should stop once loops of bowel are seen next to the uterus as this is clearly above the broad ligament. 2. For the very anteverted uterus, particularly where the fundus lies below the cervix, the parametrial volume should stop once the cervix is seen. 3. Inferiorly, the parametrial tissue finish at the muscles of the pelvic floor. 4. Anteriorly, the parametrial boundary lies at the posterior wall of the bladder. 5. In patients with a very small bladder (which lies deep in the pelvis), it was decided to set the anterior parametrial boundary in line with the posterior border of the external iliac vessels. 6. Posteriorly, the parametrial tissue is bounded by the mesorectal fascia and uterosacral ligaments. 7. Laterally, the parametrial volume should extend to the pelvic sidewall (excluding bone and muscle).
- 22. THE PARAMETRIUM IN MRI
- 24. UTEROSACRAL LIGAMNET MRI, axial view, showing the dorsal to ventral direction of the uterosacral ligament (USL) ( red arrow ) with its insertion to the cervix ( Cx ), Bladder ( B ), and rectum ( Rec
- 27. ADRESSSING UTEROSACRAL LIGAMENT 1. Care must be taken to include the entire uterosacral ligaments if they are either clinically or radiologically involved with disease. 2. If this is the case, an argument can be made to include the entire mesorectum as pararectal lymph nodes would also be at risk. 3. In that case, parametrial volumes would extend up to the rectal contour (Fig. 5). 4. Patients with (FIGO) stage 3B or greater disease and those with extensive nodal involvement should also have the entire mesorectum included in the parametrial volume
- 28. OVERLAPING WITH NODAL VOLUME 1. It is acknowledged that there would be some overlap of this volume with the nodal CTV, particularly along the obturator strip. 2. The pelvic sidewall was considered a more consistent and reproducible boundary and any overlap between the two volumes could be dealt with during treatment planning.
- 31. Vaginal Marker to be placed. Vaginal CTV extends 0.5-2 cm superior to this marker depending on thickness of vaginal cuff. CTV for postoperative radiation 31
- 32. OAR 3/16/2024 32
- 33. Post op cervix and endometrium 3/16/2024 33
- 36. 3/16/2024 36
- 37. Scan through Google lens Go to free materials 3/16/2024 37