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

If electively treating lymph node volumes, do you (for example) cover vessels that deviate far laterally higher in the pelvis, which could result in higher bowel dose? Does this impact your decision of whether or not to cover the volumes electively?

Answer from: Radiation Oncologist at Academic Institution

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 ...

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Radiation Oncologist at Coastal Carolina Radiation Oncology
Thank you for your thoughtful answer. This patient...

Radiation Oncologist at Virginia Commonwealth University Medical Center
Good question. I vaguely recall that the embryolog...

Radiation Oncologist

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...

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Radiation Oncologist at Coastal Carolina Radiation Oncology
Thank you for your thorough response. You also ans...

Radiation Oncologist at Mountain Radiation Oncology
As to lymphatic localization, here is a bit of his...

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

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