head + neck volumes

[BraggPeak]

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Is there a resource somewhere with guidelines for how to delineate tumors for primary site for head and neck? I know you typically contour GTV + 2.5 cm margin, etc; however, I heard for exam situations often times, they would like to hear you describe all the different anatomical areas you want to cover rather than just saying with tumor + margin. I haven't as yet found a good resource for this.

 

[lazers]

Kian Ang has a textbook that talks about this

 

[2x2x]

Agree with Ang/Garden suggestion. Also, Nancy Lee and Jiade Lu have a new book out: _Target Volume Delineation and Field Setup_. Lots of contours, and guidelines listed in tabular format. Covers all sites, not just HN.

 

[Neuronix]

http://books.google.com/books/about/Contouring_in_Head_Neck_Cancer.html?id=rUmBoW_f_2kC

I've been using this one. A lot of good CT pictures and contours with the recommended treatment levels by site and stage.

 

[BraggPeak]

Thanks, that was really helpful! Anyone use the Nancy Lee book as yet? Sounds like it will be a great resource for oral boards prep??

 

[skycomfort]

Ang is probably the most established. Haven't used the other books mentioned yet, but they look interesting.
There's also a new book out by Gaffney that demonstrates contouring by stage. Haven't looked at the H/N portion very much yet.

http://www.amirsyspublishing.com/specialty-imaging/radiation-oncology-imaging-and-treatment

 

[BraggPeak]

If you have a T2 N0 Supraglottic larynx tumor, how far superior and inferior would you take your CTV 70? And CTV 60?

 

[RadRadRad]

I'd put 1-1.5cm sup inf on GTV for CTV70 (tend to be more generous here than other sites b/c of potential organ motion). I tend to make sure the entire larynx is in CTV 60...I guess you could cover levels II-III in CTV 60 too, but I don't think its necessary for N0. CTV 50, I'd do levels II-IV bilaterally...stopping at transverse process C1/post belly digastric superiorly.

 

[RadRadRad]

One more thing. Assuming no chemo, I'd treat this patient with altered fractionation. If you want to stay with 50, 60, 70 Gy volumes, then 6 fractions per week would be an option.