2B treatment summaries Flashcards
Anal T1N0
Dose & volumes
T1N0
50.4Gy/28#
No elective nodal volume
GTV - Gross primary anal tumour
CTV - GTV + 1cm
Cover Anal canal, verge, internal and external anal sphincters.
Edit from bone & muscle.
PTV-P = CTV +10mm
Anal T2N0
Dose & volumes
T2 (<4cm) N0:
50.4Gy/28# to anal tumour
40Gy/28# to elective nodal volume
GTV-A = primary tumour
CTV A = GTV +10mm, entire anal canal & internal and external sphincters
Elective volume = from bifurcation of common iliac vessles (L5/S1) or 1.5cm above GTV
incl inguinal, femoral, int & ext iliac, obturator, pre-sacral nodes and perirectal nodes.
Include lower 5cm of the mesorectum, or whole mesorectum if tumour extends into it
Include ischiorectal fossa if >5mm infiltration outside levators, puborectalis muscle, external anal sphincter or anal verge, or into the ischiorectal fossa either clinically or on diagnostic imaging, or if skin involvement
PTV-P = CTV +10mm
PTV -elective = 5mm
Anal T2 >4cm, T3-4 / N+
Dose & volumes
T3-4 (&T2 >4cm) or N+:
53.2Gy/28# to primary tumour and nodes >3cm, 50.4Gy to positive nodes <3cm
40Gy to elective volume
GTV-P = primary tumour; CTV-P = GTV +15mm;
PTV-P = 10mm
GTV-N = positive nodes; CTV-N = GTV +5mm;
PTV-N = CTV+5mm
Elective volume = from 2cm above SI joint (L5/S1) or 1.5cm above GTV, inguinal, femoral, int & ext iliac, obturator, pre-sacral nodes and perirectal nodes, but not including mesorectal nodes.
Include lower 5cm of the mesorectum, or whole mesorectum if tumour extends into it
Include ischiorectal fossa if >5mm infiltration outside levators
PTV-P = CTV +10mm
PTV-N & -elective = 5mm
Anal - adj treatment
Indication: close or positive margin and no further resection possible
41.4Gy in 23# - Cover scar plus 1cm margin with MMC & Capecitabine
Include elective nodal volume if primary ≥T2 (similar to treating primary)
Breast - whole breast field borders
Whole breast - borders:
1.5cm into lung, 1cm anterior clearance
midline to mid axillary line
1cm below breast tissue (or inferior aspect of medial head of clavicle) to 1cm above breast tissue
Breast - axilla field borders
Axilla - 5-7° couch twist, single isocentre technique; borders:
Lateral border of humeral head
Med - 1cm lateral to midline
Sup - 3cm above clavicle
Inf - match to whole breast tangent, half beam blocked
Breast - SCF field borders
SCF - borders:
(Humeral head shielding unless treating axilla)
Lateral: 2/3 along clavicle
Med - 1cm lateral to midline
sup - 3cm above clavicle
Inf - matched to whole breast, 0.5cm below clavicular head
Breast - partial breast
Indications: >50 & low risk
Partial breast - Tumour bed +15mm; cropped 5mm of skin and chest wall
PTV 10mm, respecting 5mm from skin but unmodified posteriorly
Covered with tangential fields
Breast - boost
Indications: all <50, >50 & high risk (G3, LVSI+, N+, HER2+)
Boost:
CTV = tumour bed & clips, not grown for CTV, and wired scar
PTV = 5mm
Breast - chest wall
Indication: T3-4, N2, high risk N1, positive margins, residual disease after NACT
Chest wall - wire scar, include skin flaps & entire scar, underlying muscle and ribcage
Breast - whole breast and int mammary nodes
IMN (whole breast and IMN by IMRT):
Ant - 5mm from skin
Post - deep fascia
Inf - breast tissue
Sup - inferior medial clavicular head
Med - ipsilateral edge of sternum
Lat - thoracic vessels or breast tissue
PTV = 5mm
Breast - int mammary vessels
Int mammary vessels from where artery comes off subclavian artery, for first 3 ribspaces (node negative) or first 5 (IMN node positive)
CTV = 5mm, clipped from lung edge
PTV = 5mm
Bladder
55Gy/20#
CTV = whole bladder + 1cm (F) / 1.5cm (M) of urethra if base of bladder involvement
PTV = 1.5cm (2cm if dome of bladder)
Cervix
Ph1: 45Gy/25#
Ph2: 20Gy/10# EBRT boost or 21-28Gy/3-4# by IGBT
1° CRT:
GTVp = macroscopic disease on fused MRI
HR-CTV = remaining cervix
LR-CTV = CTV-HR, bilateral parametria, uterus, prox 2cm of vagina or 2cm below disease, uterosacral ligaments (& mesorectum if uterosacral ligaments involved)
ITV45 = LR-CTV + 10mm ant/post, 10mm sup/inf & 5mm laterally, and elective nodal volume
Elective nodal volume - from L5/S1 for common iliacs, and renal vessels for para-aortics - CI, II, EI, PS, O
GTV-N = positive nodes; CTV-N = GTV-N +5mm
PTV = ITV +5mm
Ph2 boost - GTVp +2cm
Chordoma
70Gy
Protons
Include whole clivus & vertebral body if affected
CNS - Glioma
Glioma
CTV = GTV +1.5cm for low and high grade
High grade planned on T1 post contrast
Low grade planned on T2
Temporal lobe lesion - include whole temporal lobe
PTV = 3mm margin
60/30
40/15
59.4/33
54/30
30/6
35/10 for re-irradiation
CNS lymphoma
CNS lymphoma
4x matrix then WBRT (if not for SCT) - 36/20 +/- 9Gy boost for partial response; Shield lens and anterior chamber after 36Gy
CR after chemo - 23.4/13#
GTV = residual tumour post chemo, CTV = 2cm, PTV = 3mm
Haem - 1° testicular lymphoma
1° testicular lymphoma - 30Gy/15# to contralateral testis
Meningioma
Adj RT - 54/30; GTV = residual tumour and reconstructed pre-op imaging for contact points of tumour. CTV = 1cm along the dura; PTV = 3mm
Radical - Gr1 - 50/30; Gr2 - 55/33; Gr3 - 60/30
GTV = primary tumour; CTV = 1cm along dura (2cm if Gr 3); PTV = 3mm
Haem - marginal zone
Marginal zone - 24Gy/12# to whole stomach, fasted for reproducibility
CTV = whole stomach +1cm and include perigastric nodes
PTV = 1cm