Variations in organ motion may be small (e.g. brain), larger and predictable (e.g. respiration or cardiac pulsation), or unpredictable (e.g. rectal and bladder filling). When treating lung tumours, the displacement of the CTV caused by respiration can be dealt with in several ways: by increasing the CTV-PTV margin eccentrically to include all CTV positions during a respiratory cycle; by using suspended respiration with a technique such as the active breathing control (ABC) device; or by delivery of radiation using gating or respiratory correlated CT scanning and treatment. Protocols for minimising effects on the CTV of variations in bladder and rectal filling are described in relevant chapters. Uncertainties from organ motion can also be reduced by using fiducial markers, and published results are available for lung, prostate and breast tumours. Radio-opaque markers are inserted and imaged at localisation using CT or MRI, and at treatment verification, using portal films, electron...
Clinical target volume (CTV) contains the GTV when present and/or subclinical microscopic disease that has to be eradicated to cure the tumour. CTV definition is based on histological examination of post mortem or surgical specimens assessing extent of tumour cell spread around the gross GTV, as described by Holland et al. (1985) for breast cancer. The GTV-CTV margin is also derived from biological characteristics of the tumour, local recurrence patterns and experience of the radiation oncologist. A CTV containing a primary tumour may lie in continuity with a nodal GTV/CTV to create a CTV-TN (e.g. tonsillar tumour and ipsilateral cervical nodes). When a potentially involved adjacent lymph node which may require elective irradiation lies at a distance from the primary tumour, separate CTV-T and CTV-N are used (Fig. 2.2), e.g. an anal tumour and the inguinal nodes. CTV can be denoted by the dose level prescribed, as for example, CTV-T50 for a particular CTV given 50Gy. For treatment of b...
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