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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
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Radiation Oncology

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