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Pawe Kukoowicz Holycross Cancer Centre Summer School of Radiotherapy Kielce, Poland 2003
ICRU 50 Prescribing, Recording, and Reporting Photon Beam Therapy 1993 When delivering a radiotherapy tretament, parameters such as volume and dose have to be specified for different purposes: prescription, recording, and reporting. It is important that clear, well defined and unambigous concepts and parameters are used for reporting purposes to ensure a common language between different centers.
Volumes
Gross Tumor Volume
The GTV is the gross palpable or visible/demonstrable extent and location of the malignant growth.
Volumes
Clinical Target Volume The CTV is a tissue volume that contains a GTV and/or subclinical microscopic malignant disease, which has to be eliminated. This volume has to be treated adequately in order to achive the aim of the therapy: cure or palliation.
Volumes
Planning Target Volume The PTV is a geometrical concept, and it is defined to selcet appropriate beam sizes and beam arrangements, taking into consideration the net effect of all the possible geometrical varaitions and inaccuracies in order to ensure that the prescribed dose is actually absorbed in the CTV.
Volumes
Treated Volume The TV is the volume enclosed by an isodose surface, selected and specified by the radiation oncologist as being appropriate to achive the purpose of treatment (e.g., tumor eradication, palliation).
Volumes
Irradiated Volume
The IrV is that tissue volume which receives a dose that is considered significant in relation to normal tissue tolerance.
Volumes
Organs at Risk
The OR are normal tissues whose radiation sensitivity may significantly influence treatment planning and/or prescribed dose.
Volumes
The GTV & CTV
the concept is clear however it is not easy to draw/delineate the GTV and CTV
GTV
GTV
GTV
GTV
CTV
CTV
CTV
CTV
PTV
... taking into consideration the net effect of all the possible geometrical variations and inaccuracies in order to ensure that the prescribed dose is actually absorbed in the CTV.
PTV
PTV (?)
Internal Margin
The motion occurs when the CTV position changes on a day-to-day level and is mainly associated with organs that are part of or adjacent to the digestive or breath system. Changes in the patients condition, such as weight gain/loss, can also affect the relative position of the CTV.
Internal Margin
K.M.Langen, D.T.L. Johnes Organ motion and its management. International Journal of Radiation Oncology Biology, Physics Vo. 50, No.1, pp. 265-278, 2001
LR 0,9
SI 1,7
AP 2,7
LR 0,9
SI 1,7
AP 2,7
Dy
Dx
SE = SD(mi)
RE = Mean(Sdi)
Set-up margin
Set-up on the CT scanner Set-up on the simulator Set-up on the therapeutic maschine
Set-up margin
C.W.Hurkmans, P. Remeijer, J.V.Lebesque, B.J.Mijnheer Set-up verification using portal imaging; review of currant clinical practice. Radiotherapy and Oncology, 58 (2000) 105-120.
Set-up errors
localisation H&N Prostate Pelvic treatment Thoratic region Breast Systematic (mm) 1,3-4,6 1,0-3,8 0,4-4,8 1,8-3,5 1,3-4,7 Random (mm) 1,2-2,1 1,2-3,0 1,1-4,9 2,3-5,4 1,7-4,4
Mantle*
2,8-3,9
2,6-3,4
van Herk M., Rasch C., Lebesque JV, The probability of correct target dosage: dose-population histograms for deriving tretment margins in radiotherapy. International Journal of Radiation Oncology Biology Physics, 2000;47:1121-1135.
Practice
Anisotropic margins with arbitratry chosen values, e.g.
rx = 0,5 cm ry = 0,8 cm rz = 1,0 cm
Conclusions
Accurate delineation of the GTV is the most important, At least to think according to ICRU 50 and 62 ideas, Minimize set-up error, To know set-up error, All the time improve the skill in drawing targets.
Conclusions
Due to the new ideas of biologically based radiotherapy the new recommendations will be needed in the nearest few years