Delineation of Radiotherapy Target Volumes for Cutaneous Malignancies Involving the Ophthalmic Nerve (Cranial Nerve V-1) Pathway

Publication date: Available online 16 March 2016
Source:Practical Radiation Oncology
Author(s): Mekhail Anwar, Yao Yu, Christine M. Glastonbury, Ivan H. El-Sayed, Sue S. Yom
PurposeThe ophthalmic nerve (cranial nerve V-1) runs in close proximity to the globe, optic nerve, chiasm, and brain. The purpose of this study was to provide contouring guidance using computed tomography (CT)-identifiable landmarks, based on an analysis of skin cancer patients with V-1 invasion.Methods and MaterialsRadiation oncology planning CT scans were analyzed for landmarks to guide V-1 target delineation from the skin surface to the trigeminal ganglion. Axial and coronal MRI sequences were fused with the planning CT to confirm soft tissue findings and identify enhancement related to perineural spread. CT/MRI-based anatomic landmarks were catalogued and described on an atlas.ResultsSoft tissue and bony landmarks were confirmed as consistently identifiable on CT with assistance from fused MRI. A reference atlas was developed that shows the entirety of the V-1 pathway on consecutive CT slices.ConclusionsInitial delineation of the V-1 pathway can be accomplished using CT-visualized landmarks confirmed on fused MRI. This CT/MRI atlas will assist radiation oncologists in delineation of the V-1 pathway.



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