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Medulloblastoma Target Volume Atlas
Medulloblastoma Target Volume Atlas
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Childrens Oncology Group
THIS PROTOCOL IS FOR RESEARCH PURPOSES ONLY, AND
SHOULD NOT BE COPIED, REDISTRIBUTED OR USED FOR
ANY OTHER PURPOSE. THE PROCEDURES IN THIS
PROTOCOL ARE INTENDED ONLY FOR USE BY CLINICAL
ONCOLOGISTS IN CAREFULLY STRUCTURED SETTINGS, AND
MAY NOT PROVE TO BE MORE EFFECTIVE THAN STANDARD
TREATMENT. A RESPONSIBLE INVESTIGATOR ASSOCIATED
WITH THIS CLINICAL TRIAL SHOULD BE CONSULTED
BEFORE USING OR ATTEMPTING ANY PROCEDURE IN THIS
PROTOCOL.
Patient positioning and treatment
planning
Treatments may be delivered prone or supine
3DCRT, IMRT or Proton therapy is required
Submission of Individual (CSI and Boost) AND
Composite isodose distributions is required
Sum of CSI and boost(s) dose distribution
Isodose display in 3 planes
Dose volume histograms
CSI and boost positioning 1/2
Some institutions choose
to treat CSI in a prone
position then use the
supine position for the
boost.
This requires two plans
to be created.
A composite plan must
be created that assumes
the cranial dose is
equivalent, irrespective
of position
CSI and boost positioning 2/2
Submission of
Composite isodose
distributions is required
What do you do if the
patient was treated in 2
positions?
While a true composite
plan cannot easily be
created, simulating the
cranial portion of the CSI
on the boost plan will allow
a reasonable estimate of
the total dose.
Digital Data Submission
Strongly consider digital data submission!
QARC can accept data in the same format as
the RTOG or other ITC (Image-guided Therapy
QA Center) trials.
Digital data submission not only can save on
hardcopy costs (color prints) it has the potential
to reduce data management time and effort.
Information on digital data submission can be
found at QARC website.
Limited Target Volume Boost
Target1
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target2
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target3
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target4
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target5
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target6
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target7
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target8
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target9
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target10
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target11
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target12
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target13
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target14
Limited Target Volume Boost
Cyan = PTV
Pink = CTV
Red = GTV
Target15
Below target
Target16
Whole Posterior Fossa Target
Volume
Above PTVPF
Right
Supratentorial Left
Brain Supratentorial
(RSB) Brain
(LSB)
TargetPF1
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
PTV
TargetPF2
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
PTV
TargetPF3
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF4
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF5
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF6
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV
GTV not drawn
Chiasm
RSB
LSB
CTV
PTV
TargetPF7
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV
GTV not drawn
RON LON
Chiasm
RSB
LSB
CTV
PTV
TargetPF8
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV R Lens
RSB
LSB
CTV
PTV
TargetPF9
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV R Lens
L Lens
RSB
LSB
CTV
PTV
TargetPF10
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV R Lens
L Lens
Hypothalamus/Pituitary
RSB
LSB
CTV
PTV
TargetPF11
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV L Lens
RSB
LSB
CTV
PTV
TargetPF12
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF13
Whole Posterior Fossa Target
Cyan = PTV Right Eye Left Eye
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF14
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF15
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
RSB
LSB
CTV
PTV
TargetPF16
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF17
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF18
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF19
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF20
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF21
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
Level of
Foramen Magnum
CTV
PTV
TargetPF22
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF23
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
CTV
PTV
TargetPF24
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
C-1
CTV
PTV
TargetPF25
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
C-1
PTV
TargetPF26
Whole Posterior Fossa Target
Cyan = PTV
Pink = CTV
GTV not drawn
C-1
PTV
TargetPF27
Below PTVPF
C-2
TargetPF28
Below PTVPF
C-2
TargetPF29
Organs at Risk
LSB RSB
OAR1
Organs at Risk
Left supratentorial brain Right supratentorial brain
LSB RSB
OAR2
Organs at Risk
Left supratentorial brain Right supratentorial brain
LSB RSB
OAR3
Organs at Risk
Left supratentorial brain Right supratentorial brain
LSB RSB
OAR4
Organs at Risk
Left supratentorial brain Right supratentorial brain
LSB RSB
OAR5
Organs
Left supratentorial brain
at Risk
Right supratentorial brain
CB
Hypothalamus/Pituitary (HPA)
OAR6
Organs at Risk
LSB RSB
CB
Brainstem (BS)
HPA
LSB RSB
CB
BS
HPA
Chiasm
LSB RSB
CB
BS
HPA
Chiasm
LON RON
OAR9
Organs at Risk
RSB
LSB CB
BS
LON RON
OAR10
Organs at Risk
CB
BS
LSB RSB
LON RON
OAR11
Organs at Risk
CB
BS
LSB RSB
OAR12
Organs at Risk
CB
BS
Right
Left
Cochlea
Cochlea
LSB RSB
OAR13
Organs at Risk
Right
Left
Cochlea
Cochlea
OAR13b
Organs at Risk
CB
BS
Right
Left
Cochlea
Cochlea
OAR14
Organs at Risk
Right
Left
Cochlea
Cochlea
OAR14b
Organs at Risk
CB
BS
OAR15
Organs at Risk
BS
OAR16
Organs at Risk
OAR17
Organs at Risk
OAR18
Organs at Risk
OAR19
Organs at Risk
OAR20
Organs at Risk
OAR21
Organs at Risk
OAR22
Organs at Risk
Spinal Cord
OAR23
Organs at Risk
OAR24
Treatment Plan Data Submission
Treatment Planning CT
Submit copies (digital or hardcopy) with contours
displayed on images for QA purposes
Isodose Display
Axial, Coronal, Sagittal display of isodose (in absolute
dose Gy)
CSI, Boost(s), AND Composite
Dose Volume Histograms
All targets and organs at risk
CSI, Boost(s), AND Composite
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