arro contour borderline resectable pancreatic cancer · arrocontour borderline resectable...
TRANSCRIPT
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ARROContour Borderline Resectable Pancreatic
Cancer
Jordan Kharofa, MD Beth Erickson, MD
Medical College of Wisconsin 8/2012
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Simulation
– Supine with arms up in
alpha cradle or other
immobilization. PO
and IV contrast if
available.
– Consider 4D-CT to
evaluate motion.
Superior/inferior
displacement may be
>1.5 cm
4D Simulation
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Contours • CTV includes
– Primary mass
– SMA origin with ~ 7mm margin
– SMA and SMV vessels adjacent to the pancreatic head
– Enlarged lymph nodes
– +/- Celiac axis depending on tumor location
• Alternative primary tumor + margin
• PTV
– PTV= CTV + 1cm expansion
– 4D-CT obtained for all patients
– Respiratory gating used if motion >1.0 cm (40-60% phase)
– ITV of primary mass created if if motion < 1.0 cm.
• OAR:
• Small bowel, large bowel, duodenum, stomach, liver, kidneys (preferentially spared if renal perfusion scan reveals dominance), cord
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Representative Target Volumes
Duodenum
GTV
Celiac CTV
PTV
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Representative Target Volumes
Duodenum
GTV SMV
Celiac CTV PTV
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Representative Target Volumes
GTV SMA CTV
SMV
Celiac CTV
Duodenum
PTV
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Representative Target Volumes
GTV
SMV SMA CTV
Duodenum
PTV
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Representative Target Volumes
SMA GTV
Duodenum
PTV
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Representative Target Volumes
Duodenum
PTV
GTV
Celiac CTV
SMA CTV
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IMRT Constraints
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50.4 Gy
30.0 Gy
45.0 Gy
15.0 Gy PTV
50.4 Gy
45.0 Gy
15.0 Gy
30.0 Gy
PTV GTV
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Dose Volume Histogram