Target Volume Delineation for Conformal and Intensity-Modulated Radiation Therapy

532 Pages·2015·105.86 MB·English

by  Nancy Y. Lee

Medical Radiology
Nancy Y. Lee
Radiation Oncology
Nadeem Riaz
L.W. Brady
Jiade J. Lu
S.E. Combs
J.J. Lu
Editors
Target Volume Delineation
for Conformal and
Intensity-Modulated
Radiation Therapy
123
Medical Radiology
Radiation Oncology
Series editors
Luther W. Brady
Stephanie E. Combs
Jiade J. Lu
Honorary editors
Hans-Peter Heilmann
Michael Molls
For further volumes:
http://www.springer.com/series/4353

Nancy Y. Lee (cid:129) Nadeem Riaz (cid:129) Jiade J. Lu
Editors
Target Volume Delineation
for Conformal and
Intensity-Modulated
Radiation Therapy
Editors
Nancy Y. Lee Jiade J. Lu
Department of Radiation Oncology Shanghai Proton and Heavy Ion Center
Memorial Sloan Kettering Cancer Center Shanghai
NY China
USA
Nadeem Riaz
Department of Radiation Oncology
Memorial Sloan Kettering Cancer Center
NY
USA
ISSN 0942-5373
ISBN 978-3-319-05725-5 ISBN 978-3-319-05726-2 (eBook)
DOI 10.1007/978-3-319-05726-2
Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014957720
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Pref ace
Historically, radiation oncologists relied on bony landmarks to determine radiation portals and
approximate areas that could be at risk for harboring gross and/or microscopic disease.
The introduction of cross-axial imaging with CT scans in the 1970s and MRIs in the 1980s
allowed us to more precisely visualize areas at risk for disease. The subsequent development
of 3D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) allowed
us to take advantage of more precise target defi nitions by sculpting the dose of radiation to
avoid critical structures. These advances afforded us the possibility to improve outcomes while
simultaneously decreasing toxicity from treatment.
However, these more precise techniques of radiotherapy pose a unique set of risks.
Conformal radiotherapy requires signifi cantly more attention to target volume delineation
(CTV) than was previously needed. For conventional 2D treatments, knowledge of bony
l andmarks was suffi cient. Comparatively, the interpretation of cross-axial imaging requires
signifi cantly more anatomic knowledge to accurately delineate target volumes (CTV). Further,
IMRT can be very unforgiving if used inappropriately. If a region is not included in the target
volume (CTV), it will receive a subtherapeutic dose and is at risk for recurrence.
R andomized trials over the past decade have demonstrated that conformal techniques can
improve outcomes in patients. These trials have also uncovered signifi cant risks from these
conformal techniques. In multiple disease sites, the quality of radiotherapy is consistently
associated with outcomes. Central review of treatment plans has demonstrated that inadequate
target volumes (PTVs and CTVs), leads to inadequate treatment, and subsequently poorer
outcomes.
Although there are many textbooks in the fi eld, most focus on the natural history of disease
and the evidence for radiotherapy, rather than on the technical details required for target
delineation. We saw an urgent need for a resource that focuses on how to delineate target
v olumes (CTVs) for radiotherapy. The best way to understand what to target is to see cases,
and so, each chapter provides slice-by-slice illustrations of target volumes on planning CT
scans. We hope this book can serve as the equivalent of the radiologist’s atlas. The text in each
chapter is focused on knowledge that is important for accurately delineating target volumes
and the reasons behind the volumes. The text is not suffi cient to understand all the important
oncologic aspects of a particular cancer, but it is suffi cient to understand the radiotherapy
technique for a particular disease.
W e hope this will serve as a valuable resource to physicians in the community, residents in
training, and others looking to understand the anatomic underpinnings of radiotherapy.
New York Nadeem Riaz
Shanghai Jiade Lu
New York Nancy Lee
v

Contents
Part I Head and Neck
Nasopharyngeal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Nadeem Riaz, Moses Tam, and Nancy Lee
Oropharyngeal Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Jeremy Setton, Ian Poon, Nadeem Riaz, Eli Scher, and Nancy Lee
Oral Cavity Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Zachary Kohutek, Keith Unger, Nadeem Riaz, and Nancy Lee
Early Stage Larynx Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Zachary S. Zumsteg, Nadeem Riaz, and Nancy Lee
Advanced Laryngeal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Daniel Higginson, Oren Cahlon, and Bhisham Chera
Hypopharyngeal Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Benjamin H. Lok, Gaorav P. Gupta, Nadeem Riaz,
Sean McBride, and Nancy Y. Lee
Carcinoma of the Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Daniel E. Spratt and Nancy Y. Lee
Major Salivary Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Yiat Horng Leong, Eli Scher, Nancy Lee, and Ivan WK Tham
Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Paul B. Romesser and Nancy Y. Lee
Squamous Cell Carcinoma of Unknown Primary in the Head and Neck. . . . . . . . . 115
John Cuaron, Nadeem Riaz, and Nancy Lee
Locally Advanced and High-Risk Cutaneous Malignancies . . . . . . . . . . . . . . . . . . . 129
Christopher A. Barker
Target Delineation of the Neck in Head and Neck Carcinomas . . . . . . . . . . . . . . . . 147
Joanne Zhung, Eli Scher, Nancy Lee, and Ruben Cabanillas
Cranial Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Ryan Lanning, Robert Young, Christopher Barker, and Nancy Lee
Part II Breast
Early Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Sagar Patel, Brian Napolitano, and Shannon M. MacDonald
Locally Advanced Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Alice Ho, Ase Ballangrud, Guang Li, Kate Krause,
Chun Siu, and Simon N. Powell
vii
viii Contents
Part III Thorax
Locally Advanced Non-Small Cell Lung Cancer
and Small Cell Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Daniel Gomez, Peter Balter, and Zhongxing Liao
Stereotactic Ablative Body Radiation (SABR) and Postoperative
Radiation in Non-Small Cell Lung Cancer (NSCLC) . . . . . . . . . . . . . . . . . . . . . . . . 241
Daniel Gomez, Peter Balter, and Zhongxing Liao
Part IV Gastrointestinal Tract
Esophageal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Jason Chia-Hsien Cheng, Feng-Ming Hsu, Abraham J. Wu,
and Lisa A. Kachnic
Gastric Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Jeremy Tey and Jiade J. Lu
Pancreatic Adenocarcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Paul B. Romesser, Michael R. Folkert, and Karyn A. Goodman
Hepatocellular Carcinoma and Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . 289
Jason Chia-Hsien Cheng, Chia-Chun Wang,
Inigo San Miguel, and Laura A. Dawson
Rectal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Jose G. Bazan, Albert C. Koong, and Daniel T. Chang
Anal Canal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Jose G. Bazan, Albert C. Koong, and Daniel T. Cang
Part V Gynecological Tract
Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Daniel R. Simpson, Anthony J. Paravati, Catheryn M. Yashar,
Loren K. Mell, and Arno J. Mundt
Uterine Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Anthony J. Paravati, Daniel R. Simpson,
Catheryn M. Yashar, Loren K. Mell, and Arno J. Mundt
Vulvar Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
John A. Vargo and Sushil Beriwal
Part VI Genitourinary System
Prostate Adenocarcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Neil B. Desai and Michael J. Zelefsky
Bladder Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Bret Adams, Dayssy A. Diaz, Alan Pollack, and Matthew Abramowitz
Testicular Seminoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Sean M. McBride
Contents ix
Part VII Central Nervous System
Benign Intracranial Disease: Benign Tumors of the Central Nervous System,
Arteriovenous Malformations, and Trigeminal Neuralgia. . . . . . . . . . . . . . . . . . . . . 401
Rupesh Kotecha, Samuel T. Chao, Erin S. Murphy, and John H. Suh
Glioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Kruti Patel and Minesh P. Mehta
Palliative Radiation for Brain Metastases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Nicholas S. Boehling, David C. Weksberg, Jiade J. Lu,
and Eric L. Chang
Part VIII Lymphoma
Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Bradford S. Hoppe and Richard T. Hoppe
Non-Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Sara Alcorn, Harold Agbahiwe, and Stephanie Terezakis
Part IX Pediatrics
Pediatric Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Arthur K. Liu and Arnold C. Paulino
Pediatric Brain Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Jeffrey Buchsbaum and Arnold C. Paulino
Part X Sarcoma
Soft Tissue Sarcoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Colleen Dickie and Brian O’Sullivan
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531