Download A Guide for Delineation of Lymph Nodal Clinical Target by Giampiero Ausili Cefaro, Carlos A. Perez, Domenico Genovesi, PDF

By Giampiero Ausili Cefaro, Carlos A. Perez, Domenico Genovesi, Annamaria Vinciguerra

ISBN-10: 3540770437

ISBN-13: 9783540770435

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"This is a concise consultant to radiological definitions of lymph node teams for radiation remedy making plans. … the first viewers is radiation oncologists in any respect levels in their careers. citizens and scholars should still locate this a truly precious anatomical consultant. The authors are renowned in radiation oncology and/or radiology. … this can be a worthwhile consultant for the lymph node anatomy of the most important affliction website regions." (James G. Douglas, Doody’s evaluation carrier, July, 2009)

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Extra info for A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy

Example text

To identify pulmonary ligament nodes (stations 9R and 9L), hilar nodes (stations 10R and 10L), and interlobar nodes (stations 11R and 11L) we have preferred a nonschematic description, provided here below: •• Pulmonary ligament lymph nodes (stations 9R and 9L) are paired lymph nodes, left and right, lying within the pulmonary ligaments. The region in which these nodes are located is difficult to identify on CT scan, since the pulmonary ligament itself is not always clearly visible. •• Hilar lymph nodes (stations 10R and 10L) are adjacent to the bifurcation of the main bronchus in left and right lobar bronchi.

Several approaches to 4D target delineation have been described [104–108] enabling reconstruction of an “internal target volume” (ITV), consisting of imaging data acquired in separate phases of respiration into a combined 3D volume containing the probable location of tumor. Allen et al. [109] created a composite volume based on the tumor delineated on maximal inhalation and exhalation scans in 16 patients. This structure was significantly smaller than a 1-cm uniform expansion around the gross tumor volume delineated on a free-breathing scan, indicating that a standard approach using a 1-cm expansion leads to overtreatment of normal tissues.

The studies of Nowak and Levendag (Rotterdam) and Gregoire (Brussels), were followed by further studies which added the anatomical margins of the nodal levels of the neck on CT scans [73, 74]. In Italy the Lombardia Cooperative Group of the Italian Society of Radiation Oncology (Associazione Italiana di Radioterapia Oncologica, AIRO) proposed guidelines for delineation of head and neck nodes on axial CT images [75, 76]. The contouring guidelines of the schools of Brussels and Rotterdam were the most commonly used in radiotherapy, but presented some differences in terms of boundaries and sizes; consequently, the need was felt to unify terminology and recommendations for contouring the individual nodal stations.

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