A guide for delineation of lymph nodal clinical target volume in radiation therapy with 12 tables

From the reviews: "This is a concise guide to radiological definitions of lymph node groups for radiation treatment planning. ... The primary audience is radiation oncologists at all stages of their careers. Residents and students should find this a very helpful anatomical guide. The authors are well known in radiation oncology and/or radiology. ... This is a useful guide for the lymph node anatomy of the major disease site regions." (James G. Douglas, Doody’s Review Service, July, 2009) Conformal radiotherapy offers the opportunity to enhance precise delivery of high dose radiation to the target volume while maintaining normal tissues doses at acceptable tolerance levels. This technique requires an exact definition of the treatment volumes: gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV). For this reason, it is important to have a very good knowledge of radiological anatomy and natural history of the disease. In particular, CTV is a tissue volume that contains the macroscopic disease with the surrounding areas suspected of subclinical involvement (CTV) and regional lymph nodes (CTV2). Delivery of adequate doses of irradiation to lymph nodes at risk, enhances treatment outcome and selective irradiation of them decreases morbitidy and yields better quality of life. To facilitate the understanding of cross-sectional anatomy detail and to assist Radiation Oncologists on the difficult task of a detailed delineation of lymph node targets in multiple anatomical locations, the editors compiled this work. The book opens with a brief overview of the anatomy of the lymphatic system, followed by the main anatomical classifications involving lymph drain in four main regions (head and neck, mediastinum, superior abdomen, pelvis) and describes the spreading patterns of the different cancers. Based on close collaboration between Radiologists and Radiation Oncologists, explicit instructions for lymph nodal clinical target volumes delineation are proposed to obtain a more accurate and consistent definition of these volumes of interest; axial topographic reference points for anatomical boundaries of regional lymph nodes are presented in illustrative tables. A folding page, containing of one side the anatomical-radiological tables and on the other the CT axial images, will facilitate the reading of CT images reported in the book from the head and neck region to the pelvic one. The editors hope that this book will be a valuable Image-guided 3D Conformal or Intensity Modu- by the various classifcation systems, which might lated Radiation Terapy aims to deliver high doses be hard to fnd in scans performed without contrast of radiation to the tumor, while trying to maintain medium. dose levels to healthy tissue within tolerable limits. Together with experienced radiologists for each Terefore, it is of key importance to defne the dif- anatomical region, we have developed a set of st- ferent target volumes, gross tumor volume (GTV), dards for the acquisition of planning CT images, clinical target volume (CTV), planning target vol- standardizing the parameters for scan performance ume (PTV), and organs at risk (OARs), on the basis and those concerning patient positioning and - of in-depth knowledge of the human anatomy, of mobilization. anatomicoradiological aspects, and of anatomical In the second section of the book we describe the and geometric variations during the radiation plan- role and importance of radiological imaging in ta- ning and treatment. get defnition, including lymph nodes, especially for We have prepared this guide to meet the needs image-guided radiation therapy (IGRT). cover-large.jpg 1 front-matter.pdf 2 Sec1 General Considerations.pdf 11 1.01 Anatomy.pdf 12 1.02 Lymph Node Classification.pdf 20 1.03 Anatomicoradiological Boundaries.pdf 37 1.04 Planing CT- Technical Notes.pdf 47 SecII Target Volume Delineation in Modern Radiation Therapy.pdf 51 2.05 Critical Importance of Target Definition, Including Lymph Nodes, in Image-Guided Radiation Therapy.pdf 52 SecIII Axial CT Radiological Anatomy.pdf 68 3.06 Head and Neck Lymph Nodes.pdf 69 3.07 Mediastinal Lymph Nodes.pdf 102 3.08 Upper Abdominal Region Lymph Nodes.pdf 118 3.09 Pelvic Lymph Nodes.pdf 141 3.10 Digitally Reconstructed Radiographs (DRRs).pdf 165 back-matter.pdf 166 Front Matter....Pages I-XII Front Matter....Pages 1-1 Anatomy....Pages 3-10 Lymph Node Classification....Pages 11-27 Anatomicoradiological Boundaries....Pages 29-38 Planing CT: Technical Notes....Pages 39-42 Front Matter....Pages 43-43 Critical Importance of Target Definition, Including Lymph Nodes, in Image-Guided Radiation Therapy....Pages 45-60 Front Matter....Pages 61-61 Head and Neck Lymph Nodes....Pages 63-95 Mediastinal Lymph Nodes....Pages 97-112 Upper Abdominal Region Lymph Nodes....Pages 113-135 Pelvic Lymph Nodes....Pages 137-160 Digitally Reconstructed Radiographs (DRRs)....Pages 161-161 Back Matter....Pages 163-173 This book will facilitate the understanding of cross-sectional anatomy details and assist radiation oncologists in the difficult task of a detailed delineation of lymph node targets in multiple anatomical locations. Giampiero Ausili Cefaro ... [et Al.], Eds. Includes Bibliographical References (p. 163-173).