Target delineation in Pelvicmalignancies在盆腔恶性肿瘤靶区.pptVIP

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2018-06-19 发布于福建
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Target delineation in Pelvicmalignancies在盆腔恶性肿瘤靶区.ppt

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Target delineation in Pelvicmalignancies在盆腔恶性肿瘤靶区

Target delineation in Pelvic malignancies Thastro March 20-22nd Pierre Scalliet MD, PhD, HFRCR ICRU definitions GTV Demonstrable macroscopic tumour (CT scan, MRI, PET-CT,other…). Does not apply to postoperative RT. Does not apply in situations where the tumour is not easy to see: prostate and rectum cancer. Long learning curve, need for training or “retraining” in modern imaging Lymphatic CTVin the pelvis Lymphatic CTVin the pelvis Cervix cancer imaging with MRI (GTV) Cervix cancer imaging with MRI (GTV) Cervix cancer imaging with MRI (GTV) 3D imaging ofbrachytherapy Inter-observer variation in delineation for cervix cancer Poor organ definition with CT Organ definition sometimes difficult with CT due to lack of contrast. MRI offers much better contrast for soft tissue. Combination of CT with MRI offers a good solution for anatomy definition. CTV for cervix cancer Volumes in rectum cancer Characterisation of rectal cancer: standard is MRI Characterisation of rectal cancer: standard is MRI Rectum cancer: before and after chemoradiation Rectum cancer: before and after chemoradiation Rectum cancer: before and after chemoradiation Prostate cancer Prostate cancer CTV PTV? Systematic deviations Random deviations PTV? Calculating the PTV Calculating the PTV Repeated (3/w) portal imaging in 30 patients treated for various tumors scatter plot reporting the discrepancies in the beam axis of portal images relative to simulation films in Centre A and Centre B ITV? Respiratory movements ITV? Respiratory movements (16/min) Cardiac beats (80/min) Random movements (bowel, bladder, etc…) ITV? ITV? Question without answer… Towards multidimensional conformal radiotherapy? * * Gross Tumor Volume: GTV Clinical Target Volume: CTV Internal Target Volume: ITV Planning Target Volume: PTV Organ at Risk: OAR Planning Organ at Risk Volume: PRV ICRU 50 62 Lengelé Scalliet. RO 2008 EPUB Common pathways for the pelvic wall and pelvic organs. Minor lymphatics are seldom invaded if major ly