What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?

For women treated with IMRT, there are multiple ways to define the upper border of the field

1) contouring the PAs up to where the renal vessels exit the aorta

2) Treated up to vertebral body levels (i.e. T12/L1 or L1/2)

3) Treat to a certain distance (i.e. 3 cm) or vertebral body above a known positive lymph node

How do you contour the CTV, do you use only one method, or alternate between them? Any benefits to one approach over another?

Answer from: Radiation Oncologist at Community Practice

For prophylactic pa nodal region treatmentIi treat up to the renal vessels and dont use any bony landmark.If there is a node up to the renal vessels that is involved, then I consider extending 2 to 3 cm above the involved node including and contouring retrcrural region.See below reference for above ...

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What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?

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