Whole pelvic irradiation for post hysterectomy


Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy in Postoperative Treatment of Endometrial and Cervical Cancer.

 RTOG trial 0418 led an international collaboration to define an atlas of target definitions for postoperative pelvic RT for endometrial and cervical cancer. We try to make a plan with CTV complying with the guidelines by using 'template'.

 Target site                                       Definition          

 Common iliac lymph nodes        From 7 mm below L4–L5 interspace to level   

                                           of bifurcation of common iliac arteries into

                                 external and internal iliac arteries  

    External iliac lymph nodes         From level of bifurcation of common iliac artery

                                                into external artery to level of superior aspect

                                                    of femoral head where it becomes femoral artery

    Internal iliac lymph nodes          From level of bifurcation of common iliac artery

                                     into internal artery, along its branches

                                      (obturator, hypogastric) terminating in

                                            paravaginal tissues at level of vaginal cuff  

     Upper vagina                              Vaginal cuff and 3 cm of vagina inferior to cuff     

            Parametrial/paravaginal tissue  From vaginal cuff to medial edge of internal obturator   

                                 muscle/ischial ramus on each side  

  Presacral lymph nodes*            Lymph node region anterior to S1and S2 region  

(*If patient has cervical cancer or endometrial cancer with cervical stromal invasion.)

                                                                                 RTOG trial 0418

Rotational center : center of PTV

Dose indication point : vaginal stump



last modification date: 2007/11/28