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Consensus guidelines and contouring atlas for pelvic node delineation in prostate and pelvic node intensity modulated radiation therapy

Harris, Victoria A., Staffurth, John Nicholas ORCID:, Naismith, Olivia, Esmail, Alikhan, Gulliford, Sarah, Khoo, Vincent, Lewis, Rebecca, Littler, John, McNair, Helen, Sadoyze, Azmat, Scrase, Christopher, Sohaib, Aslam, Syndikus, Isabel, Zarkar, Anjali, Hall, Emma and Dearnaley, David 2015. Consensus guidelines and contouring atlas for pelvic node delineation in prostate and pelvic node intensity modulated radiation therapy. International Journal of Radiation Oncology*Biology*Physics 92 (4) , pp. 874-883. 10.1016/j.ijrobp.2015.03.021

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Purpose The purpose of this study was to establish reproducible guidelines for delineating the clinical target volume (CTV) of the pelvic lymph nodes (LN) by combining the freehand Royal Marsden Hospital (RMH) and Radiation Therapy Oncology Group (RTOG) vascular expansion techniques. Methods and Materials Seven patients with prostate cancer underwent standard planning computed tomography scanning. Four different CTVs (RMH, RTOG, modified RTOG, and Prostate and pelvIs Versus prOsTate Alone treatment for Locally advanced prostate cancer [PIVOTAL] trial) were created for each patient, and 6 different bowel expansion margins (BEM) were created to assess bowel avoidance by the CTV. The resulting CTVs were compared visually and by using Jaccard conformity indices. The volume of overlap between bowel and planning target volume (PTV) was measured to aid selection of an appropriate BEM to enable maximal LN yet minimal normal tissue coverage. Results In total, 84 nodal contours were evaluated. LN coverage was similar in all groups, with all of the vascular-expansion techniques (RTOG, modified RTOG, and PIVOTAL), resulting in larger CTVs than that of the RMH technique (mean volumes: 287.3 cm3, 326.7 cm3, 310.3 cm3, and 256.7 cm3, respectively). Mean volumes of bowel within the modified RTOG PTV were 19.5 cm3 (with 0 mm BEM), 17.4 cm3 (1-mm BEM), 10.8 cm3 (2-mm BEM), 6.9 cm3 (3-mm BEM), 5.0 cm3 (4-mm BEM), and 1.4 cm3 (5-mm BEM) in comparison with an overlap of 9.2 cm3 seen using the RMH technique. Evaluation of conformity between LN-CTVs from each technique revealed similar volumes and coverage. Conclusions Vascular expansion techniques result in larger LN-CTVs than the freehand RMH technique. Because the RMH technique is supported by phase 1 and 2 trial safety data, we proposed modifications to the RTOG technique, including the addition of a 3-mm BEM, which resulted in LN-CTV coverage similar to that of the RMH technique, with reduction in bowel and planning target volume overlap. On the basis of these findings, recommended guidelines including a detailed pelvic LN contouring atlas have been produced and implemented in the PIVOTAL trial. The PIVOTAL trial was funded by Cancer Research United Kingdom(CRUK) 10/022, C5907/A11880, and C1491/A9895 and supported by National Institute for Health Research (NIHR) Clinical Research Network at participating sites. PIVOTAL was coordinated by CRUK-funded Clinical Trials and Statistics Unit, Institute of Cancer Research. We acknowledge NHS funding to the NIHR Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research. Conflict of interest: none.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Publisher: Elsevier
ISSN: 0360-3016
Date of Acceptance: 20 March 2015
Last Modified: 31 Oct 2022 10:48

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