60 year-old female with high grade urothelial carcinoma invading the uterine wall, cervix and anterior vaginal wall, status post radical cystectomy, hysterectomy, bilateral salpingo-oophorectomy and anterior vagina resection. Pathology revealed multifocal positive margins with 12 of 35 examined lymph nodes involved, pT4a pN2 cM0 (Stage IVA).
Technique:
Dose
Simulation:
Per 2022 IBIS Update of Consensus Guidelines
CTVcb (cystectomy bed):
*A more extensive CTV may be preferable to include surgical clips or in the case of extranodal tumor involvement.
*Do not crop CTV to bowel
CTVn (nodes)
Presacral nodes:
Iliac nodes:
Obturatornodes
CTV to PTV margins: uniform 0.5 to 0.7 cm expansion
Per 2016 Contouring Guidelines
The urinary diversion OAR is contoured to avoid bringing beams directly through this structure, without compromising target coverage.
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