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).
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
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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