Contouring <3

Question 1

What nodes are included in post-op gastric?

Answer 1

CTV includes 1cm on: (trimmed off anatomic boundaries)
- Celiac artery take-off
- SMA
- Portal vein outside of liver
- Pancreas head
- Duodenum
- Aorta from GEJ down to inf most contour
- INCLUDE PARAESOPHAGEAL FOR GEJ/CARDIAC TUMOR

These will include the celiac axis nodes (D2), pancreaticoduodenal nodes and suprapancreatic nodes (D3) and the para-aortic nodes D4)

Question 2

What nodal regions are included in pancreas cancer treatment? borderline resectable/unresectable?

Answer 2

ITV is made from combination of GTVs. Then CTV = ITVp + following:
- Contour 1cm around first 1.5cm of celiac artery, 3cm of SMA.

Nodal regions included are:
- SMA, Celiac, porta hepatis, portal vein

Question 3

Cholamgio:
What indications for RT and when

Answer 3

SWOG is really the only trial; not even randomized. In this, sx -> gem+cape -> CRT with cape alone: for extrahepatic (includes biliary tree and gallbladder tumors):

Don’t really do 4DCT, makes it complicated. Instead, do:
- CTV: pre-op GTV+tumorbed+surgical clips/draining regional lymph nodes + 1CM <3 PTV 7mm

Lymph nodes:
- porta hepatis, SMA, celiac axis (SAME AS PANCREAS), but include pancreaticoduodenal