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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