How do you design pelvic lymph node treatment volumes for patients with tortuous or aberrant vascular anatomy?

So much of what we do comes down to a risk-benefit analysis, since it's really not possible to be sure that an individual patient will benefit from a proposed treatment. However, in this situation, if you would offer the treatment if the patient had normal anatomy, then I would offer it in the case ...

In such cases, I would contour the blood vessels in all target regions, including the aberrant vascular anatomy, and expand this contour in the usual fashion (≈7 mm) to produce a CTV. Consistent with prior guidance, I would then subtract out the bowel bag which often overlaps with the CTV, even in p...