CPB Ljubljana 2018 course book

Target Volume Concept Work in Progress (not for clinical use yet)

GTV

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Clincial findings at brachytherapy: ▪

Macroscopic palpable and visible residual tumor (clincial drawing)

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T2 weighted MRI findings at brachytherapy: ▪

Residual high / intermediate signal intensity mass

CTV

HR

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GTV

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Clinical palpable indurations

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T2 weighted MRI ▪

Residual hypointense area’s in vaginal wall Abnormal thickened or deformed vaginal wall

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▪ Residual ‘grey zones’ in paravaginal / parametrial compartments CTV IR ➢ HR-CTV + 0.5 cm isotropic margin ▪

limited by previously unaffected anatomical borders / compartents: pubic bone, pelvic wall, pelvic floor musculature,bladder, urethra, mesorectal fascia, rectum, anal sphinqter ▪ In case of invasion of hollow organs at diagnosis (bladder/rectum), include wall without the lumen ➢ If necesary expand to minimally include the initial GTV extension at diagnosis (clincial and or MRI) Low Risk Vagina ➢ Remaining vaginal wall that is not included in IR-CTV ➢ Volume for dose reporting: ▪ α/β 10 since included in the primary tumor related external beam radiotherapy CTV at diagnosis ▪ α/β 3 to relate to vaginal morbidity

Courtesy of R. Nout for GEC-ESTRO VTG