Anal

Question 1

Anal cancer RT dosing

Answer 1

T2 - Primary 50.4 Gy in 28 fx with 42 in 28 to elective nodes
T3/4 - Primary 54 Gy in 30 fx with 45 in 30 to elective nodes
Boost < 3cm nodes to 50.4 in 30 fx and > 3 cm nodes to 54 Gy in 30 fx

Question 2

Anal cancer Rt volumes

Answer 2

Anal GTV +1 cm = CTV
Nodal GTV + .5 cm = CTV n
CTV elective = at least 2 cm inferior to anal GTV, includes mesorectum, inguinal, perirectal, presacral, internal and external iliacs to the level of the bifurcations of common iliacs

Question 3

Borders of the inguinal nodes

Answer 3

inguinal ligament to lesser trochanter
lateral - rectus femoris
medial - adductor longus and pectineus
Posterior- iliopsoas and pectineus
Anterior - sartorius

Question 4

Anal cancer staging: T staging

Answer 4

T1 - tumor 2 cm or less
T2 - > 2 cm - </= 5 cm
T3 - > 5 cm
T4 - tumor of any size that invades adjacent organs

Question 5

Anal cancer staging: N staging

Answer 5

N1a - inguinal, meorectal, superior rectal, internal iliac or obturator nodes
N1b - external iliac nodes
N1c - N1a and N1b

Question 6

Anal cancer constraints: femoral heads

Answer 6

V45 < 20%

Question 7

Anal cancer constraints: Small bowel

Answer 7

V45 < 10%, 20 cc
V50 < 10 cc

Question 8

Anal cancer constraints: bowel bag

Answer 8

V45 < 195 cc

Question 9

Anal cancer constraints: Bladder

Answer 9

V50 < 30%

Question 10

Anal cancer constraints: Genitalia

Answer 10

V30 < 20%
V20 < 67%

Question 11

Anal cancer constraints: Pelvic bone marrow

Answer 11

V10 < 90%