GTVp	Primärtumor-Volumen
CTVp	GTVp + 7 mm	Primärtumor, clinical target volumen
PTVp	CTVp + 5 mm	Primärtumor, physical target volumen
GTVn	befallene Lymphknoten
CTVn	GTVn + 5 mm	befallene Lymphknoten, clinical target volumen
PTVn	CTVn + 5 mm	befallene Lymphknoten, physical target volumen
HN3	PTVp + PTVn	ca. 70 Gy, makroskopisch befallenes Gebiet
CTVhr Volumen mit hohem Risiko z,B. ipsilateral Level II,III,IV PTVhr CTVhr + 5 mm   HN2 HN3 + PTVhr ca. 59 Gy CTVlr Volumen mit niedrigem Risiko z.B. kontalateral Level II, III, IV PTVlr CTVlr + 5 mm   HN1 HN2 + PTVlr z.B. 50Gy
3-Feldertechnik	volumen Diese 3-Feldertechnik wurde bis vor wenigen Jahren eingesetzt. Heute obsolet! Die Parotis ist beiderseits zu 100% erfasst.
Fraktionierung	MARCH: Meta-Analysis of Radiotherapy in Carcinomas of Head and neck Collaborative Group.
Mukositis	Dische Scoringsystem für akute Mukositis Kriterium 0 1 2 3 4 Mucosal reactions none slight erythema marked erythema spotted mucositis confluent mucositis Area involved none =25% 25– 50% 50–100% Edema none slight moderate severe Bleeding none slight incidental slight, multifocal marked, regular Ulceration none single, superficial multifocal, superficial single, profound multifocal, profound Dysphagia (diet) normal exclusion of some food soft, pulp food only fluids only tube feeding or intravenous alimentation Pain none during eating only constant, but moderate, non-steroidal analgesics constant, serious, narcotics needed
Xerostomie	Durch Gabe von 25mg Bethachenol kann die akute Xerostomie verringert werden(2).
Schilddrüse	Die Bestrahlung von HNO - Tumoren führt gelegentlich zu einer Hypothyreose(1).
LK-Level	RTOG - Definition LEVEL CRANIAL CAUDAL ANTERIOR POSTERIOR LATERAL MEDIAL Ia Geniohyoid m., plane tangent to basilar edge of mandible Plane tangent to body of hyoid bone Symphysis menti, platysma m. Body of hyoid bone Medial edge of ant. belly of digastric m. n.a.a Ib Mylohyoid m., cranial edge of submandibular gland Plane through central part of hyoid bone Symphysis menti, platysma m. Posterior edge of submandibular gland Basilar edge / innerside of mandible, platysma m., skin Lateral edge of ant. belly of digastric m. IIa Caudal edge of lateral process of C1 Caudal edge of the body of hyoid bone Post. edge of submandibular gland; ant. edge of int. carotid artery; post. edge of post. belly of digastric m. Post. Border of int. jugular vein Medial edge of sternocleidomastoid Medial edge of int. carotid artery, paraspinal (levator scapulae) m. IIb Caudal edge of lateral process of C1 Caudal edge of the body of hyoid bone Post. Border of int. jugular vein Post. border of the sternocleidomastoid m. Medial edge of sternocleidomastoid Medial edge of int. carotid artery, paraspinal (levator scapulae) m. III Caudal edge of the body of hyoid bone Caudal edge of cricoid cartilage Postero-lateral edge of the sternohyoid m.; ant. edge of sternocleidomastoid m. Post. edge of the sternocleidomastoid m. Medial edge of sternocleidomastoid Int. edge of carotid artery, paraspinal (scalenius) m. IV Caudal edge of cricoid cartilage 2 cm cranial to sternoclavicular joint Anteromedial edge of sternocleido-mastoid m Post. edge of the sternocleidomastoid m. Medial edge of sternocleidomastoid Medial edge of internal carotid artery, paraspinal (scalenius) m. V Cranial edge of body of hyoid bone CT slice encompassing the transverse cervical vesselsb Post. edge of the sternocleidomastoid m. Ant. border of the trapezius m. Platysma m., skin Paraspinal (levator scapulae, splenius capitis) m. VI Caudal edge of body of thyroid cartilagec Sternal manubrium Skin; platysma m. Separation between trachea and esophagus Medial edges of thyroid gland, skin and ant.-medial edge of sternocleidomastoid m. n.a. Retro- pharyngeal Base of skull Cranial edge of the body of hyoid bone Fascia under the pharyngeal mucosa Prevertebral m. (longus colli, longus capitis) Medial edge of the internal carotid artery Midline
Kosten USA (5)	Analyse der Zahlungen von Medicare (USA)aus dem Jahr 2016 Radikaloperation ~$18,000 Bestrahlung nach konventioneller 3-D Planung ~$32,000 IMRT ~$95,000.
Quellen	1.) Turner SL, Tiver KW, Boyages SC: Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1995;31:279-83 2.) Jaguar GC, et al.: Double blind randomized prospective trial of bethanechol in the prevention of radiation-induced salivary gland dysfunction in head and neck cancer patients. Radiotherapy and Oncology 2015;115:253–256 3.) Mazeron JJ, Ardiet JM, Haie-Meder C, et al.: GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol 2009;91:150-156 4.) Garden AS, Beadle BM, Gunn BG: Radiotherapy for Head and Neck Cancers: Indications and Techniques. 5th Edition Wolters & Cluver 2017 5.) Razfar A, Mundi J, Grogan T, et al.: IMRT for head and neck cancer: Cost implications. Am J Otolaryngol. 2016;37(6):479-483. doi:10.1016/j.amjoto.2015.02.017. 6.) Yong JHE, et al.: Estimating the costs of intensity-modulated and 3-dimensional conformal radiotherapy in Ontario. Curr Oncol 2016;23:e228-e238
wichtiger Hinweis!	Für die Richtigkeit von Dosisangaben, Zielvolumina und Indikationen kann keine Garantie übernommen werden. In Zweifelsfällen sind die aktuellen nationalen und internationalen Leitlinien einzusehen.

Impressum                           Zuletzt geändert am 20.12.2015 11:54