Borders, Doses, & TD 5/5

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TD 5/5 Testes

100 cGy

Hemoglobin normal range

13.2-16.9

Platelets normal range

140,000-390,000

TD 5/5 Lung

1750 cGy

Inverted Y - Lateral borders

2 cm beyond pelvic inlet (exclude as much of the pelvis as possible while leaving adequate margin around lymphatics)

Nasopharynx - # of fields

2-3 (laterals and AP)

TD 5/5 Ovary

200 cGy

TD 5/5 Kidney

2300 cGy

TD 5/5 Pancreas

2500 cGy

WBC normal range

3.9-10.0 thousand

TD 5/5 Bone Marrow (segmental)

3000 cGy

TD 5/5 Liver

3000 cGy

Hodgkin's - Total dose & fx

3000-3600 (microscopic disease) 3600-4400 cGy (gross disease) 180-200 cGy ~20 fx

Hematocrit normal range

38.5-49%

RBC normal range

4.2-5.7 million

TD 5/5 Brain

4500 cGy

TD 5/5 Intestines

4500 cGy

TD 5/5 Pituitary

4500 cGy

TD 5/5 Spinal Cord

4500 cGy

TD 5/5 Bone

6000 cGy

TD 5/5 Brain - partial

6000 cGy

TD 5/5 Esophagus

6000 cGy

TD 5/5 Oral cavity

6000 cGy

TD 5/5 Pharynx

6000 cGy

TD 5/5 Thyroid Cartilage

6000 cGy

Larynx total dose & fx

6600-7000 cGy (early tumors) 7000-7500 cGy (advanced tumors) *off cord at 4500 cGy for lateral fields 200 cGy/33-35 fx (not including boost)

TD 5/5 Larynx

7000 cGy

TD 5/5 Muscle

>10,000 cGy

TD 5/5 Breast

>5000 cGy

T1 Larynx - Posterior border

Anterior margin of the vertebral bodies

Nasopharynx - Superior border

Entire sphenoid sinus, cavernous sinus, base of skull (with at least 0.5 cm margin)

Breast Sclav - Superior border

Extends laterally across the neck and trapezius to the acromial process

Mantle - Lateral

Fall-off, to include axillary nodes

Breast Sclav - Lateral border

From the acromioclavicular joint, bisecting the humeral head, to exclude as much of the shoulder as possible. A custom cut block may be used to block humeral head.

Breast - Blocking

Humeral head, thyroid, lung, heart

T2 Larynx - Inferior border

Infraglottic extension and 2-3 cm margin

Larynx - Lymphatics

Jugulodigastric, mid-jugular, low jugular *no nodal involvement in early stage

Paraaortic - Inferior border

L4/L5

Nasopharynx - Anterior border

Posterior 2 cm of nasal cavity (or 2 cm beyond tumor extension), posterior 1/3 of the maxillary sinus, posterior ethmoid sinuses, and posterior or 1/4 of orbit

Nasopharynx - Lymphatics

Retropharyngeal, deep cervical, jugulodigastric, superior jugular, mid-jugular

Hodgkin's Side Effects - Acute

Skin changes (erythema, dry + moist desquamation), N/V, fatigue, loss of appetite, weight loss, diarrhea, low CBC

Breast Side Effects - Acute

Skin changes (erythema, dry + moist desquamation), fatigue, rib fracture, mastitis, cellulitis

Nasopharynx - Blocking

Spinal cord, base of brain, mandible, eye, mouth, midline block on anterior field

T2 Larynx - Superior border

Surpaglottic extension and 2-3 cm margin

Larynx - Blocking

T1: no blocking necessary T2: spinal cord, mandible, oral tongue T3/T4: mandible, tongue, posterior aspect of brain, spinal cord Supraglottic: same as T3/T4

Mantle - Inferior border

T9/T10 interspace or insertion of diaphragm

Nasopharynx Side Effects - Chronic

Tissue fibrosis, necrosis

Larynx Side Effects - Chronic

Tissue fibrosis, voice changes, necrosis

T1 Larynx - Superior border

Top of thyroid cartilage

Paraaortic - Lateral border

Usually 9-10 cm wide (blocks may be cut to encompass spleen or splenic pedicles)

Breast Sclav - Inferior border

1st costal interspace, abutting the tangential breast field

Inverted Y - Inferior border

2 cm below ischial tuberosity to include femoral nodes

Larynx - # of fields

2-3 (parallel opposed laterals/AP for advanced)

Hodgkin's - Energy

6 MV

Larynx - Energy

6 MV

Nasopharynx - Energy

6 MV

Breast - Energy

6 MV or higher depending on patient separation

Breast Tangents - Inferior border

1.5 cm below inframammary fold

T1 Larynx - Anterior border

1.5-2 cm beyond the thyroid cartilage

T2 Larynx - Anterior border

1.5-2 cm beyond the thyroid cartilage

T3/T4 Larynx - Anterior border

1.5-2 cm beyond the thyroid cartilage

Breast Tangents - Superior border

1st costal interspace

TD 5/5 Heart

4000 cGy

TD 5/5 Stomach

4500 cGy

TD 5/5 Thyroid gland

4500 cGy

TD 5/5 Lens

500 cGy

TD 5/5 Cornea

5000 cGy

TD 5/5 Ear

5000 cGy

TD 5/5 Lymph nodes

5000 cGy

TD 5/5 Optic chiasm

5000 cGy

TD 5/5 Salivary glands

5000 cGy

Breast Tangents - Total dose & fx

5000 cGy 6000 cGy (boost) 200 cGy or 267 fx 25 fx plus boost or 15 fx plus boost

Breast Sclav - Total dose & fx

5000 cGy 200 cGy 25 fx

TD 5/5 Retina

5500 cGy

TD 5/5 Skin

5500 cGy

Paraaortic - Superior border

Approx mid-T10, with an appropriate gap from mantle field

Breast - Lymphatics

Axillary, supraclavicular, infraclavicular, subclavian, internal mammary

Nasopharynx - Posterior border

Behind the spinous processes to include the retropharyngeal nodes, posterior pharyngeal wall, deep cervical nodes, or posterior cervical nodes.

T1 Larynx - Inferior border

Below the cricoid cartilage

T3/T4 Larynx - Inferior border

Below the cricoid cartilage

Supraglottic Larynx - Inferior border

Bottom of the cricoid cartilage and 2 cm below the lowest extent of disease

Nasopharynx - Inferior border

Cricoid cartilage

Nasopharynx - Total dose & fx

Initial laterals: 5040 cGy (off cord at 4500 cGy) Boost: 6500 cGy (T1-T2) 7000-7500 cGy (T3-T4) Anterior neck field: 4500-5000 cGy 180 cGy Initial laterals: 28 fx With boost: 36-42 fx Anterior neck field: 25-28 fx

Inverted Y - Superior border

L5 with an appropriate gap from abdominal port

Mantle - Superior border

Lower mandible and the mastoid tips (chin must be extended so that high cervical and submandibular nodes are included in the port, without treating mouth.

Hodgkin's - Blocking

Mantle: Humeral heads, lungs, occipital, anterior larynx, spinal cord Inverted Y: spinal cord, left kidney (when treating spleen), liver, ovaries, gonads, femoral heads, bladder, rectum

Hodgkin's - Lymphatics

Mantle: cervical, submandibular, axillary, supraclavicular, infraclavicular, mediastinal, hilar Paraaortic & Pelvic: retroperitoneal, paraaortic, pelvic, splenic hilar, femoral

Breast Tangents - Lateral border

Mid-axillary line (2 cm beyond all breast tissue)

T2 Larynx - Posterior border

Mid-vertebral bodies

Breast Tangents - Medial border

Midline

Breast Side Effects - Chronic

Necrosis, secondary cancer

T3/T4 Larynx - Superior border

Node negative: 2 cm above the angle of the mandible to treat the jugulodigastric nodes Node positive: Above the mastoid process to cover the entire jugulodigastric lymph node chain (the hyoid bone and epiglottis are included to incorporate the pre-epiglottic space)

T3/T4 Larynx - Posterior border

Node negative: Behind the mastoid process to include the midjugular nodes Node positive: Behind the spinous process to include the posterior cervical lymph nodes

Nasopharynx Side Effects - Acute

Skin changes (erythema, dry + moist desquamation), fatigue, hoarseness, mucositis, xerostomia, weight loss, low CBC, dysphagia/odynophagia

Larynx Side Effects - Acute

Skin changes (erythema, dry + moist desquamation), fatigue, loss of appetite, hoarseness/sore throat, weight loss, low CBC, dysphagia/odynophagia

Hodgkin's Side Effects - Chronic

Tissue fibrosis, necrosis, fistula

Breast Sclav - Medial

Vertical 1 cm across midline (or at midline) extending from the 1st costal interspace to the thyro-cricoid groove, medial to the sternocleidomastoid muscle to include the lower lymph nodes of the cervical chain.


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