title: Variation in "supraclavicular" lymph node depth is partly determined by treatment position.
abstract: BACKGROUND
  The so-called "supraclavicular" region bears the confluence of deep jugular, upper mediastinal and axillary lymph node groups and therefore it is often part of the target volume in common malignancies like lung cancer, breast cancer and head and neck cancer. For treating this area, several authors recommend an anterior portal with the dose prescribed to a tissue depth of 3 cm, which does not fit our institution's experience.
  
  
  METHODS
  In 119 consecutive patients a computed tomography for planning purposes was performed. We used the subclavian blood vessels between clavicula and first rib as an estimate of the confluence of the mentioned lymph node regions and determined their tissue depth (which does not describe the deepest part of the lymph vessels).
  
  
  RESULTS
  Mean and median of the tissue depth were 5 cm in a range from 2 to 9 cm. Only in less than 20% of the measurements we found the vessels located 3 cm or less under the surface which would correspond to a depth of the lymph node target volume 4 to 5 cm. Increasing body mass resulted in deeper location of the vessels. The position of the patient's arms influenced the tissue depth even more. Arms risen above the head resulted in 55% of the measurements in tissue depths of 6 cm or deeper compared to 6% in patients treated with arms beside the body.
  
  
  CONCLUSIONS
  Standardized treatment prescriptions do not cope adequately with individual anatomy. Treatment position especially of the arms influences location of the "supraclavicular" lymph node region in thoracic treatment. Target volume delineation by computed tomography seems the most accurate solution, although it is the most expensive one. Patient immobilization is crucial for accuracy of treatment delivery.
authors.affiliation: Klinikum Duisburg, Wedau Kliniken, Germany.
authors.forename: H T
authors.initials: HT
authors.lastname: Klages
authors.forename: F
authors.initials: F
authors.lastname: Szafinski
authors.forename: H B
authors.initials: HB
authors.lastname: Makoski
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed