It opens with a brief overview of the anatomy of the lymphatic system, followed by the main anatomical classifications involving the lymph drain in four main regions head and neck, mediastinum, superior abdomen, pelvis and describes the spreading patterns of the different cancers.
Based on the close collaboration between radiologists and radiation oncologists, explicit instructions for the delineation of lymph nodal clinical target volumes are proposed to obtain a more accurate and consistent definition of these volumes of interest. In addition, axial topographic reference points for anatomical boundaries of regional lymph nodes are presented in illustrative tables. This book will be a valuable aid in accurate image-based radiation therapy planning for young as well as for more experienced radiation oncologists.
Customer Reviews Average Review. See All Customer Reviews. The authors concluded that esophagograms and endoscopies were more accurate than CT scans in approximating esophageal cancer lengths, and there were larger differences between CT scans and pathological specimens. For example, standard uptake values, resolution of PET, local inflammation, and target volume reductions might influence clinical benefits. There are also other methods for determining esophageal carcinoma lengths. This method can be used to accurately delineate the GTV. It is very important to accurately determine the length and position of the primary tumor of the esophagus.
In our opinion, the optimal solution should combine considerations from the examinations mentioned above.
Lymph node involvement is another crucial factor for the treatment of esophageal cancers, especially for patients who are unfit for or refuse operation, and for defining chemoradiotherapy staging and target volume. There were no statistically significant differences in accuracies between these methods. EUS has also been used to determine lymph node statuses, but can only visualize lymph nodes close to the esophageal wall.
For the determination of the GTVnd, enhanced CT was the most commonly used method in radiotherapy treatment planning. These results have been recommended by the National Comprehensive Cancer Network guidelines and the Chinese guideline of radiotherapy for esophageal carcinoma.
A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy
There is still no consensus for determining the CTVnd. The irradiation fields have primarily been determined based on postoperative pathological lymphatic spread results. The lymph nodes at risk are included in the CTV, according to the location of the primary tumor.
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The suggested CTVnd included the area from the cervical paraesophageal and supraclavicular lymph nodes to the main bronchus lymph nodes for the upper esophagus, the whole mediastinal lymph nodes, including the left gastric artery lymph nodes for the middle esophagus, and the area from the lower thoracic paraesophageal lymph nodes to the left gastric artery lymph nodes of the lower esophagus. The cervical paraesophageal and supraclavicular lymph nodes should not include the CTVnd, and skip metastases are an important mode for esophageal cancer.
[Full text] Delineation of clinical target volume for postoperative radiotherapy i | OTT
The current delineation of CTVnd for definitive radiotherapy of esophageal cancer in China included supraclavicular, paraesophageal, paratracheal, subaortic, and subcarinal lymph nodes for the upper esophagus, paraesophageal, paratracheal, subaortic, and subcarinal lymph nodes for the middle esophagus, and paraesophageal, paratracheal, subaortic, subcarinal, and left gastric artery lymph nodes for the lower esophagus.
Since the reports of International Commission on Radiation Units and Measurements 50 and 62 defined the internal target margin of radiotherapy, several investigations have studied the movement of the esophagus. The internal target volume ITV of the esophagus takes into account physiological organ movements, particularly those as a result of respiration and cardiac impulse, to ensure adequate coverage of the CTV. Accurate data from clinical trials is required, because target variation could lead to significant daily dose variations for the target volume and adjacent normal tissues.
These authors suggested daily image guidance throughout the course of treatment in conformal radiotherapy for esophageal cancer. There was no correlation between the two modalities of imaging, as Furthermore, the cone beam CT could identify rotation variations. To summarize the above references and results, we published the guidelines of radiotherapy for esophageal cancer in , in China, in the Chinese Journal of Cancer. CTVnd The involved locoregional node, preferred to cover only. Adjust according to the measurement data and position of the lesion.
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Abstract Esophageal carcinoma is a lethal disease that is endemic to many parts of the world, particularly in the Taihang Mountains of China. Figure 1 Open in figure viewer PowerPoint.
The GTV is defined on computed tomography CT slices as a macroscopic primary tumor and involved lymph nodes.