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Table 1 Various Guidelines for Pelvic Node CTV Drawing

From: Assessment of nodal target definition and dosimetry using three different techniques: implications for re-defining the optimal pelvic field in endometrial cancer

  Common Iliac External Iliac Internal Iliac Obturator
Portaluri* Cranial: Aortic bifurcation Cranial: Common iliac bifurcation (L5-S1) Cranial: Common iliac bifurcation (L5-S1) Cranial: Cranial sections of obturator muscle
  Caudal: Common iliac bifurcation Caudal: Femoral ring (disappearance of lateral muscles of abdominal wall, artery becomes lateral) Caudal: Cranial sections of coccygeal muscle Caudal: Superior margin inferior branch of pubic bone
  Anterior: Mesocolon Anterior: Fat of small bowel, deferent duct or round ligament Anterior: Bladder, uterus Anterior: External iliac vein
  Lateral: Psoas muscles Lateral: Lateral: Lateral:
  Posterior: sacrum    - Cranial: Psoas, int iliac vein, iliac bone, sacroiliac joint    - Cranial: Psoas muscle, int iliac vein, iliac bone, sacroiliac joint    - Cranial: Acetabulum
      - Caudal : Piriformis m., internal obturatorius m.    - Caudal : Piriformis m., int obturatorius m.    - Caudal: Internal obturator muscle
   Posterior: Posterior: Posterior: Internal obturator muscle
      - Cranial: Ext iliac v    - Cranial: Sacral wing Medial: Bladder
      - Caudal: Pubic bone (superior branch)    - Caudal: Piriform muscle  
   Medial: Mesocolon, uterus, bladder Medial: Mesocolon, uterus, bladder  
Taylor† 7 mm around common iliac vessels, extending posterior and lateral borders to psoas and vertebral body 7 mm around ext iliac vessels, extending anterior border by additional 10 mm anterolaterally along ilopsoas muscle to include lateral external iliac nodes 7-mm margin around int iliac vessels, extending lateral borders to pelvic sidewall 18-mm wide strip along pelvic sidewall joining external and internal iliac regions
Shih†† 2.0 cm expansion around the distal 2.5 cm of common iliac vessels superior to bifurcation 2.0 cm expansion around ext iliac vessels for 9 cm from common iliac bifurcation 2.0 cm expansion around int iliac vessels for 8.5 cm extending from common iliac bifurcation Not specified
RTOG 0418|| 7 mm around common iliac vessels, with superior border at 7 mm below L4-L5 interspace 7 mm around ext iliac vessels, terminating at level of femoral head 7 mm around int iliac vessels Not specified
  1. * Portaluri M BS, Perez C, et al. A three-dimensional definition of nodal spaces on the basis of CT images showing enlarged nodes for pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2005;63:1101-1107.
  2. † Taylor A RA, Reznek RH, et al. Mapping pelvic lymph nodes: Guidelines for delineation in intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2005;63:1604-1612.
  3. †† Shih HA HM, Zietman AL, et al. Mapping of nodal disease in locally advanced prostate cancer: Rethinking the clinical target volume for pelvic nodal irradiation based on vascular rather than bony anatomy. Int J Radiat Oncol Biol Phys 2005;63:1262-1269.
  4. || Jhingren A, Winter K, Portelance L. A phase II study of intensity modulated radiation therapy (IMRT) to the pelvic for post-operative patients with endometrial carcinoma (RTOG 0418). Int J Radiat Oncol Biol Phys 2008; 72:S16-S17