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mary CTV:
• GTV
• Cervix
• Parametria
• Uterus
• Upper Vagina
• Involved organs
Nodal CTV:
• lymph-nodes and draining areas
bowel loop round ligament
Parametrium = the lateral extension of the uterine subserous connective tissue into the broad ligament
Anatomical boundaries
Anteriorly Posterior wall of bladder/bowel loops or posterior border of external iliac vessel
Posteriorly Uterosacral ligaments and mesorectal fascia
Laterally Medial border of internal obturator muscle/ pelvic sidewall
Superiorly Top of fallopian tube/ broad ligament
Inferiorly Depending on vaginal tumor extension, pelvic floor
Initial CTV components: LR-CTV-Tinitial