{"id":13994,"date":"2026-03-11T23:39:56","date_gmt":"2026-03-12T02:39:56","guid":{"rendered":"https:\/\/rtmedical.com.br\/tmp-en-1773283192097\/"},"modified":"2026-04-04T18:06:56","modified_gmt":"2026-04-04T21:06:56","slug":"esophageal-cancer-delineation","status":"publish","type":"post","link":"https:\/\/rtmedical.com.br\/en\/esophageal-cancer-delineation\/","title":{"rendered":"Esophageal Cancer: Target Delineation and Fields"},"content":{"rendered":"<div class=\"toc\">\n<h2>In This Article<\/h2>\n<ul>\n<li><a href=\"#planning-principles\">1. General Planning and Simulation Principles<\/a><\/li>\n<li><a href=\"#anatomic-subdivisions\">2. Anatomic Subdivisions of the Esophagus<\/a><\/li>\n<li><a href=\"#gtv-ctv-ptv\">3. GTV, CTV, and PTV Delineation<\/a><\/li>\n<li><a href=\"#nodal-coverage\">4. Nodal Coverage by Tumor Location<\/a><\/li>\n<li><a href=\"#siewert-stein\">5. Siewert\u2013Stein Classification for GEJ Tumors<\/a><\/li>\n<li><a href=\"#summary-table\">6. Contouring Recommendations by Subdivision<\/a><\/li>\n<li><a href=\"#clinical-cases\">7. Illustrated Clinical Cases<\/a><\/li>\n<\/ul>\n<\/div>\n<h2 id=\"planning-principles\">General Planning and Simulation Principles<\/h2>\n<p>Radiation planning for <strong>esophageal cancer<\/strong> requires thorough knowledge of cervical, mediastinal, and abdominal anatomy, along with reliable motion compensation techniques. Both IMRT and 3D-CRT demand accurate delineation of target volumes, normal structures, and organs at risk (OARs), plus careful dose-volume histogram evaluation during planning.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignright lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-pet-scan-cervical-scc.jpeg\" alt=\"PET-CT showing FDG-avid cervical\/upper thoracic esophageal squamous cell carcinoma with paratracheal lymph node\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/830;\"><figcaption>Fig. 14.1 \u2014 PET-CT of cervical\/upper thoracic SCC. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>At simulation, patients should ideally have their arms above the head to maximize beam arrangement options without beams traversing the upper extremities. For distal or gastroesophageal junction (GEJ) tumors, respiratory motion compensation is essential: 4D CT scanning, respiratory gating, or breath-hold techniques. Patients should remain nil per os (NPO) for at least 2\u20133 hours before simulation and each treatment session to limit daily anatomic variation from gastric and bowel gas.<\/p>\n<p>For IMRT planning, intravenous contrast at simulation helps better delineate nodal fields. Contrast-enhanced planning CT improves distinction between lymph nodes and adjacent vascular structures \u2014 particularly important in the mediastinum.<\/p>\n<p>For a broader perspective on target volume delineation across multiple anatomic sites, see our <a href=\"https:\/\/rtmedical.com.br\/en\/gastric-cancer-delineation\/\">dedicated article on gastric cancer<\/a>, which shares several abdominal planning principles with the distal esophagus.<\/p>\n<h2 id=\"anatomic-subdivisions\">Anatomic Subdivisions of the Esophagus<\/h2>\n<p>The esophagus begins in the neck at the lower border of the cricoid cartilage (anterior to the sixth cervical vertebra) and descends through the mediastinum, passing through the diaphragm into the abdomen. Using the standard 40 cm distance from the incisors to the GEJ, the subdivisions are defined as follows:<\/p>\n<ul>\n<li><strong>Cervical esophagus<\/strong>: from the incisors to approximately 15\u201320 cm<\/li>\n<li><strong>Upper thoracic (proximal) esophagus<\/strong>: from 18\u201320 cm to approximately 25 cm<\/li>\n<li><strong>Lower thoracic (mid\/distal) esophagus<\/strong>: from 25 cm to 30\u201332 cm<\/li>\n<li><strong>Abdominal esophagus<\/strong>: from 30\u201332 cm to 40 cm<\/li>\n<\/ul>\n<p>This anatomic subdivision directly guides CTV contouring and the selection of elective nodal stations. Tumors spanning multiple subdivisions should follow the contouring guidelines for all involved subsets.<\/p>\n<p>Regardless of tumor location, the entire lungs must be contoured for adequate DVH analysis. For upper esophageal malignancies, the brachial plexus and larynx should be delineated. For lower esophageal tumors, the heart, liver, kidneys, stomach, and adjacent bowel must be included as OARs.<\/p>\n<h2 id=\"gtv-ctv-ptv\">GTV, CTV, and PTV Delineation<\/h2>\n<p>The following target structures should be delineated: <strong>GTV<\/strong> (gross tumor volume), <strong>CTV<\/strong> (clinical target volume), and <strong>PTV<\/strong> (planning target volume). An <strong>ITV<\/strong> \u2014 the volume encompassing the internal motion of the GTV observed on 4D CT \u2014 is routinely defined at institutional level. The ITV is expanded to a CTV, then to a PTV.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-contours-cervical-scv-nodes.jpeg\" alt=\"Radiation planning contours for cervical esophageal SCC with bilateral supraclavicular nodal coverage\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/808;\"><figcaption>Fig. 14.1 (cont.) \u2014 Contours showing supraclavicular nodal coverage. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>Physicians should delineate the GTV with reference to CT and PET imaging, as well as findings on upper endoscopy and endoscopic ultrasound (EUS). EUS is particularly valuable for staging tumor invasion depth and classifying small periesophageal lymph nodes that are difficult to assess by CT or PET alone. If the tumor is superior to the carina, bronchoscopy is recommended to rule out tracheoesophageal fistula, which may delay radiotherapy.<\/p>\n<p>Standard ITV-to-CTV expansions are <strong>1 cm radially<\/strong> (to encompass periesophageal lymph nodes) and <strong>3\u20134 cm in the superior-inferior direction<\/strong> (oriented along the esophageal mucosa) to account for submucosal spread and possible skip lesions. The CTV expansion can be limited to 0.5 cm in areas overlapping the heart and uninvolved liver, assuming appropriate motion management.<\/p>\n<p>For distal and GEJ tumors, a 4 cm caudal margin would include large volumes of stomach or abdominal viscera. The recommendation is <strong>only 2 cm margin to CTV along clinically uninvolved gastric mucosa<\/strong> \u2014 unless treating with preoperative-intent doses (\u22644500 cGy), where a 4 cm or greater gastric margin may be appropriate, particularly for tumors with significant gastric extension.<\/p>\n<p>Uninvolved vertebral bodies and kidneys are excluded from the CTV. For involved lymph nodes, a GTV-to-CTV margin of 0.5\u20131.0 cm is used. If grossly involved periesophageal nodes are present, the CTV should cover at least 1 cm cephalad to them. The recommended CTV-to-PTV expansion is <strong>0.5 cm<\/strong>.<\/p>\n<h2 id=\"nodal-coverage\">Nodal Coverage by Tumor Location<\/h2>\n<p>Regional lymph node inclusion in the CTV depends on the location of the primary tumor within the esophagus. Getting this right is critical \u2014 under-coverage risks regional failure, while over-coverage increases toxicity needlessly.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignright lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-lower-thoracic-adenocarcinoma-pet-1.jpeg\" alt=\"PET-CT of lower thoracic esophageal adenocarcinoma uT3N1 showing primary uptake and level 4R paratracheal lymph node\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/276;\"><figcaption>Fig. 14.2a \u2014 PET of lower thoracic adenocarcinoma uT3N1. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p><strong>Cervical and proximal thoracic esophagus:<\/strong> bilateral supraclavicular nodal basins are included. The cranial boundary is the lower edge of the cricoid cartilage; the anterior, posterior, and lateral boundaries are defined by the sternocleidomastoid muscle. For proximal thoracic tumors, mediastinal lymph nodes are included beyond the periesophageal nodes \u2014 encompassing the entire trachea, levels 2 and 4, extending toward the sternum and clavicular heads to cover level 3.<\/p>\n<p><strong>Distal thoracic esophagus:<\/strong> the CTV should include the celiac nodes, bounded on the right by the lateral aspect of T12, on the left 0.5\u20131 cm beyond the lateral aspect of the aorta, posteriorly by the vertebral bodies, and anteriorly by the pancreas. It is not necessary to include superior mediastinal nodal stations electively, beyond overlap with the cranial expansions.<\/p>\n<p><strong>GEJ tumors:<\/strong> the CTV should include para-aortic and gastrohepatic ligament nodes, in a volume bounded by the liver on the right and the stomach on the left. For tumors also requiring abdominal planning, see our <a href=\"https:\/\/rtmedical.com.br\/en\/pancreatic-cancer-delineation\/\">article on pancreatic cancer<\/a>, which discusses celiac axis anatomy and motion management in detail.<\/p>\n<h2 id=\"siewert-stein\">Siewert\u2013Stein Classification for GEJ Tumors<\/h2>\n<p>When GEJ tumors significantly overlap the gastric cardia, the question of esophageal versus gastric origin becomes ambiguous. The Siewert\u2013Stein classification addresses this by defining GEJ tumors according to their epicenter relative to the junction:<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-ge-junction-contours-celiac-1.jpeg\" alt=\"Radiation planning contours for gastroesophageal junction adenocarcinoma uT3N0 with celiac axis coverage\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/909;\"><figcaption>Fig. 14.3 \u2014 GEJ adenocarcinoma uT3N0 with celiac axis coverage. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<ul>\n<li><strong>Type I<\/strong>: epicenter 1\u20135 cm above the junction<\/li>\n<li><strong>Type II<\/strong>: epicenter from 1 cm proximal to 2 cm distal to the junction<\/li>\n<li><strong>Type III<\/strong>: epicenter 2\u20135 cm below the junction<\/li>\n<\/ul>\n<p>A reasonable cutoff for esophageal cancer is Siewert type II. The eighth edition AJCC staging system now defines esophageal tumors as those whose epicenter extends no more than 2 cm into the gastric cardia. For Siewert type II tumors, some or all of the splenic hilum and greater curvature nodal region may be included in the CTV.<\/p>\n<p>Based on prevailing guidelines for gastric cancers, diagnostic laparoscopy, J-tube placement, preoperative or postoperative chemoradiation can be considered. For more detail on gastric planning, see our <a href=\"https:\/\/rtmedical.com.br\/en\/gastric-cancer-delineation\/\">dedicated article on gastric cancer<\/a>.<\/p>\n<h2 id=\"summary-table\">Contouring Recommendations by Esophageal Subdivision<\/h2>\n<p>The following table summarizes the recommended margins, elective nodal coverage, and dose prescriptions for each anatomic subdivision of the esophagus. These data form the backbone of treatment planning \u2014 keep them accessible during contouring.<\/p>\n<table>\n<thead>\n<tr>\n<th>Subdivision<\/th>\n<th>Definition<\/th>\n<th>ITV\u2192CTV Margin<\/th>\n<th>CTV\u2192PTV Margin<\/th>\n<th>Elective Nodal Coverage<\/th>\n<th>Dose<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Cervical<\/td>\n<td>Incisors to ~15\u201320 cm<\/td>\n<td>3 cm sup\/inf (mucosa), 1 cm radial<\/td>\n<td>0.5 cm<\/td>\n<td>Periesophageal, supraclavicular, \u00b1 anterior mediastinal<\/td>\n<td>50.4 Gy at 1.8 Gy\/fx, boost to 60\u201370 Gy for SCC<\/td>\n<\/tr>\n<tr>\n<td>Upper thoracic<\/td>\n<td>18\u201320 cm to ~25 cm<\/td>\n<td>3 cm sup\/inf (mucosa), 1 cm radial<\/td>\n<td>0.5 cm<\/td>\n<td>Periesophageal, supraclavicular, \u00b1 anterior mediastinal<\/td>\n<td>50.4 Gy at 1.8 Gy\/fx<\/td>\n<\/tr>\n<tr>\n<td>Lower thoracic<\/td>\n<td>25 cm to ~37 cm<\/td>\n<td>3 cm sup\/inf (mucosa), 1 cm radial<\/td>\n<td>0.5 cm<\/td>\n<td>Periesophageal<\/td>\n<td>50.4 Gy (definitive); 41.4\u201350.4 Gy (preoperative)<\/td>\n<\/tr>\n<tr>\n<td>Abdominal (GEJ)<\/td>\n<td>~37 to 42 cm<\/td>\n<td>3 cm sup (esoph. mucosa) + 1\u20132 cm inf (gastric mucosa); \u22654 cm gastric if preop \u22644500 cGy<\/td>\n<td>0.5 cm<\/td>\n<td>Periesophageal, gastrohepatic ligament (paracardiac + left gastric), celiac axis, \u00b1 splenic hilum<\/td>\n<td>50.4 Gy (definitive); 41.4\u201350.4 Gy (preoperative)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em>Source: Target Volume Delineation and Field Setup: A Practical Guide for Conformal and Intensity-Modulated Radiation Therapy, 2nd Edition (Table 14.1)<\/em><\/p>\n<h2 id=\"clinical-cases\">Illustrated Clinical Cases<\/h2>\n<p>The following cases, drawn directly from the textbook, illustrate the practical application of these guidelines in real-world scenarios. Each case demonstrates how to integrate PET, endoscopy, and EUS findings into volume contouring.<\/p>\n<h3>Case 1: Cervical\/Upper Thoracic SCC \u2014 69-Year-Old<\/h3>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignright lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-endoscopy-adenocarcinoma-1.jpeg\" alt=\"Endoscopy showing partially obstructing circumferential esophageal adenocarcinoma 31-35 cm from incisors\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 345px; --smush-placeholder-aspect-ratio: 345\/275;\"><figcaption>Fig. 14.2b \u2014 Endoscopy showing obstructing adenocarcinoma. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>A 69-year-old patient with SCC of the cervical\/upper thoracic esophagus. PET-CT revealed FDG-avid primary and mildly avid paratracheal lymph nodes. EGD showed an ulcerating submucosal mass 15\u201323 cm from the incisors. Delineated volumes included: brachial plexus (purple), larynx (yellow), esophageal GTV (red), nodal GTV (green), CTV (orange), PTV 54 Gy (cyan), and PTV 60 Gy (dark blue). The superior border of the supraclavicular field was placed at the inferior border of the cricoid cartilage, with bilateral elective SCV nodal coverage.<\/p>\n<h3>Case 2: Lower Thoracic Adenocarcinoma \u2014 81-Year-Old, uT3N1<\/h3>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-eus-t3-primary-1.jpeg\" alt=\"Endoscopic ultrasound showing T3 primary disease and suspicious level 4R lymph node in esophageal cancer\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 343px; --smush-placeholder-aspect-ratio: 343\/275;\"><figcaption>Fig. 14.2c \u2014 EUS showing T3 disease and suspicious level 4R node. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>An 81-year-old patient with lower thoracic esophageal adenocarcinoma uT3N1. PET showed primary uptake and level 4R paratracheal lymph node. Endoscopy revealed a partially obstructing circumferential adenocarcinoma 31\u201335 cm from the incisors. EUS confirmed T3 primary disease with suspicious level 4R node. Contours applied a 0.5 cm GTV-to-CTV margin for the 4R node and 3\u20134 cm inferior coverage. Volumes: brachial plexus (purple), stomach (dark green), esophageal GTV (red), ITV (pink), nodal GTV (light green), CTV (orange), PTV 50.4 Gy (dark blue).<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignright lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-lower-thoracic-contours-4r.jpeg\" alt=\"Axial planning contours for lower thoracic esophageal adenocarcinoma showing 0.5 cm GTV-to-CTV margin at level 4R node and 3-4 cm inferior coverage\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/851;\"><figcaption>Fig. 14.2 (cont.) \u2014 Axial contours with 4R nodal margin. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<h3>Case 3: GEJ Adenocarcinoma \u2014 75-Year-Old, uT3N0<\/h3>\n<p>A 75-year-old patient with GEJ adenocarcinoma uT3N0. Contours demonstrate CTV extension into the proximal stomach with coverage to the celiac axis. Delineated volumes: stomach (dark green), large bowel (brown), esophageal GTV (red), CTV (orange), PTV 50.4 Gy (cyan). Celiac axis coverage is mandatory for distal and GEJ tumors.<\/p>\n<h3>Case 4: GEJ Adenocarcinoma \u2014 59-Year-Old, uT3N2<\/h3>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-ge-junction-adenocarcinoma-pet.jpeg\" alt=\"PET-CT and sagittal planning CT for gastroesophageal junction adenocarcinoma uT3N2 with FDG-avid paraesophageal node\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/844;\"><figcaption>Fig. 14.4 \u2014 PET and sagittal CT of GEJ uT3N2. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>A 59-year-old patient with GEJ adenocarcinoma uT3N2. PET showed FDG-avid paraesophageal nodes and primary located 36\u201340 cm from the incisors. The sagittal planning CT shows the ITV reflecting GTV movement, with CTV covering 3\u20134 cm above the ITV. Volumes: stomach\/duodenum (dark green), nodal GTV (light green), esophageal GTV (red), ITV (pink), CTV (orange), PTV 50.4 Gy (cyan). Paraesophageal lymph nodes were included in the treatment field.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"alignright lazyload\" data-src=\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/04\/esophageal-paraesophageal-ln-contours.jpeg\" alt=\"Axial contours showing inclusion of paraesophageal lymph node in CTV for gastroesophageal junction adenocarcinoma\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 691px; --smush-placeholder-aspect-ratio: 691\/803;\"><figcaption>Fig. 14.4 (cont.) \u2014 Paraesophageal lymph node inclusion. Source: Target Volume Delineation and Field Setup, 2nd Edition<\/figcaption><\/figure>\n<p>For similar principles applied to other thoracic and abdominal sites, see our <a href=\"https:\/\/rtmedical.com.br\/en\/lung-cancer-target-delineation\/\">article on lung cancer<\/a> and the <a href=\"https:\/\/rtmedical.com.br\/en\/rectal-cancer-target-delineation\/\">discussion on rectal cancer<\/a>, covering respiratory motion management and pelvic delineation respectively.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Esophageal cancer target delineation: ITV-CTV-PTV margins, nodal coverage by subdivision, and Siewert\u2013Stein classification with clinical cases.<\/p>\n","protected":false},"author":1,"featured_media":16553,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"ngg_post_thumbnail":0,"fifu_image_url":"","fifu_image_alt":"","footnotes":""},"categories":[265,99,268],"tags":[],"class_list":{"0":"post-13994","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-delineamento-volumes","8":"category-radiotherapy","9":"category-delineamento-torax-gi"},"aioseo_notices":[],"rt_seo":{"title":"Esophageal Cancer RT Target Delineation","description":"Target volume delineation for esophageal cancer radiotherapy. CTV margins by location, nodal coverage, GEJ considerations and OAR constraints.","canonical":"","og_image":"","robots":"default","schema_type":"MedicalWebPage","include_in_llms":false,"llms_label":"","llms_summary":"","faq_items":[{"q":"How are CTV margins defined for esophageal cancer?","a":"The CTV includes the GTV with 3-4 cm craniocaudal margin and 1 cm radial margin for submucosal spread. Longitudinal margins may be reduced to 2 cm distally for GEJ tumors. At-risk regional nodes are included based on tumor location within the esophagus."},{"q":"Which nodal stations are included by esophageal tumor location?","a":"Upper esophageal tumors require supraclavicular and upper mediastinal nodal coverage. Middle esophageal tumors include subcarinal and periesophageal nodes. Lower esophageal and GEJ tumors include celiac axis, left gastric, and perigastric nodes."},{"q":"What motion management is needed for esophageal cancer RT?","a":"The esophagus is subject to respiratory and cardiac motion, particularly in the distal portion. 4D-CT may be used to assess motion and generate an ITV. Adequate PTV margins (typically 0.5-1 cm) account for residual setup error and internal organ motion."}],"video":[],"gtin":"","mpn":"","brand":"","aggregate_rating":[]},"_links":{"self":[{"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/posts\/13994\/"}],"collection":[{"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/posts\/"}],"about":[{"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/types\/post\/"}],"author":[{"embeddable":true,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/users\/1\/"}],"replies":[{"embeddable":true,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/comments\/?post=13994"}],"version-history":[{"count":2,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/posts\/13994\/revisions\/"}],"predecessor-version":[{"id":16605,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/posts\/13994\/revisions\/16605\/"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/media\/16553\/"}],"wp:attachment":[{"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/media\/?parent=13994"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/categories\/?post=13994"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rtmedical.com.br\/en\/wp-json\/wp\/v2\/tags\/?post=13994"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}