文档介绍：（优选）鼻咽癌CTV勾画上
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2010年2月24日 全身PET-CT显像示
鼻咽部异常增厚软组织影，代谢异常增高，考虑鼻咽癌，向上侵犯蝶窦，向前累及后鼻孔区
左颈部淋巴结代谢异常增高，考虑转移性病变；余双侧tructures)
• Whole nasopharynx
5–10 mm from mucosal surface of nasopharynx Anterior: Junction with nasal choana Lateral: Medial border of parapharyngeal space Caudal: Caudal border of C1 vertebra·
• CTV_70 + 5 mm margin (2 mm if abut neurologic or bony structures)
• Posterior nasal cavity
Anterior: Posterior third of nasal cavity
• Posterior maxillary sinuses
Anterior: Posterior third of maxillary sinuses
• Lower sphenoid sinus
Cranial: Lower half of sphenoid sinus
• Pterygoid fossae
• Parapharyngeal spaces
Lateral: Lateral border of styloid processes
• Base of skull
Posterior: Anterior half of clivus if no gross invasion, whole clivus if invasion detected
Lateral: Lateral border of foramen ovale
• Elective nodal levels
All: Bilateral retropharyngeal, level II, III, VA
If node-positive: Add level IB
• Upper sphenoid sinus (if sphenoid involved)
Part of sphenoid sinus at and above the level of optic chiasma
• Elective nodal levels
Bilateral levels IV and VB
Based on guideline currently used at Pamela Youde Nethersole Eastern Hospital (Hong Kong)
CTV Delineation Hong Kong
head
neck
background
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CTV Delineation
head
neck
background
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Background
Head
Neck lymph nodes
normality
involvement
recurrence
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Structures Involved
Frequency (%)
Adjacent soft tissue
Nasal cavity
87
Parapharyngeal space
68
Pterygoid muscle (medial, lateral)
48
Prevertebral muscle
19
Bony erosion/paranasal sinus
Clivus
41
Sphenoid bone, foramina lacerum, ovale, rotundum
38
Pterygoid plates, pterygomaxillary fissure, pterygopalatine fossa
27
Petrous bone, petro-occipital fissure
19
Ethmoid sinus
6
Maxillary antrum
4
Jugular foramen, hypoglossal canal
4
Pituitary fossa/gland
3
Structures Involved
background
neck
head
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