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Table 14 Guidelines for contouring larynx (according to subsites)

From: Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

Supraglottic larynx Superior limit Inferior limit Ipsilateral limit Contralateral limit Anterior limit Posterior limit
CTV 1 GTV + 0.5-1 cm margin idem Idem idem Idem idem
CTV 2 Epiglottis, base of tongue (1 cm from CTV HD), arytenoids Inferior border of chricoid cartilage Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, chricoid cartilage (plus pyriform sinus depending on GTV) Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, chricoid cartilage Hyoid bone, thyroid cartilage, omohyoid and sternohyoid muscle anterior to pre-epiglottic space, thyroid cartilage, chricoid cartilage Epiglottis, posterior limit of thyroid cartilage, arythenoids
CTV 3 Optional (add margin from CTV 2) Idem Idem Idem Idem idem
Glottic larynx
CTV1 GTV + 0.5-1 cm margin idem Idem idem idem idem
CTV2 sub-hyoid epiglottis and pre-epiglottis space anterior to sub-hyoid epiglottis, hyoid bone, arytenoid Inferior border of cricoid cartilage Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, cricoid cartilage (plus pyriform sinus and thyroid gland depending on GTV) Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, cricoid cartilage Hyoid bone, thyroid cartilage, omohyoid and sternohyoid muscle anterior to pre-epiglottic space, thyroid cartilage, cricoid cartilage Epiglottis, posterior limit of thyroid cartilage, arythenoids
CTV 3 Optional (add margin from CTV 2) Idem Idem Idem Idem idem
Subglottic larynx
CTV 1 GTV + 0.5-1 cm margin idem Idem idem idem idem
CTV2 Epiglottis, base of tongue (1 cm from CTV HD), arytenoids Superior limit of first tracheal cartilage (or lower depending on GTV) Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, chricoid cartilage, homolateral thyroid gland Hyoid bone, thyrohyoid, omohyoid and sternohyoid muscle laterally to thyroid cartilage, chricoid cartilage Hyoid bone, thyroid cartilage, omohyoid and sternohyoid muscle anterior to pre-epiglottic space, thyroid cartilage, chricoid cartilage Retrochrycoid region, arythenoids, (upper oesophageal opening depending on GTV)
CTV 3 Optional (add margin from CTV 2) Idem Idem Idem Idem idem