Target delineation in Pelvic malignancies在盆腔恶性肿瘤靶区-精选文档.ppt
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1、ICRU definitions,Gross Tumor Volume: GTV Clinical Target Volume: CTV Internal Target Volume: ITV Planning Target Volume: PTV Organ at Risk: OAR Planning Organ at Risk Volume: PRV,ICRU 50 & 62,GTV,Demonstrable macroscopic tumour (CT scan, MRI, PET-CT,other). Does not apply to postoperative RT. Does n
2、ot apply in situations where the tumour is not easy to see: prostate and rectum cancer. Long learning curve, need for training or “retraining” in modern imaging,Lymphatic CTV in the pelvis,Lengel & Scalliet. R&O 2008 EPUB,Common pathways for the pelvic wall and pelvic organs. Minor lymphatics are se
3、ldom invaded if major lymphatics are free,Lymphatic CTV in the pelvis,Lengel & Scalliet. R&O 2008 EPUB,Proposal for a common classification in 7 levels, by similarity with H&N or thoracic classification.,Cervix cancer imaging with MRI (GTV),Ptter R et al. R&O 2006, 78: 67,Initial MRI; FIGO stage IIB
4、; Invasion of right parametria, disparition of cervix rim, fluid collection in cervix canal. Drawing of clinical staging under anesthesia,Cervix cancer imaging with MRI (GTV),Ptter R et al. R&O 2006, 78: 67,MRI after 50 gy RT-CT, before brachytherapy. Partial restoration of cervix rim. Regression of
5、 parametrial invasion. Drawing of clinical staging under anesthesia,Cervix cancer imaging with MRI (GTV),Ptter R et al. R&O 2006, 78: 67,3D imaging of brachytherapy,Ptter R et al. R&O 2006, 78: 67,Total dose calculated as the sum of the extrenal radiotherapy dose and the brachytherapy dose, with a b
6、iological correction for the variation in dose rate and dose per fraction.,Inter-observer variation in delineation for cervix cancer,Dimopoulos J et al. R&O 2008 EPUB,Poor organ definition with CT,Organ definition sometimes difficult with CT due to lack of contrast. MRI offers much better contrast f
7、or soft tissue. Combination of CT with MRI offers a good solution for anatomy definition.,CTV for cervix cancer,Small W et al. IJROBP 2008, 71:428,Volumes in rectum cancer,Characterisation of rectal cancer: standard is MRI,T2 image through mesorectum demonstrating a large T3 tumour with extramural e
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