Anatomic study of the pelvis in carcinoma of the uterine cervix as related to the box technique

Zunino, Silvia; Rosato, Otilio; Lucino, Sergio; Jáuregui, Esteban; Rossi, L; Venencia, C

doi:10.1016/s0360-3016(98)00538-0

Cited by 54 publications

(36 citation statements)

References 8 publications

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“…Lymphangiograms, surgical techniques and CT/MRI imaging (Bonin et al, 1996;Zunino et al, 1999;McAlpine et al, 2004) were used to identify the adequacy of pelvic lymph node coverage in the past few years. Pendlebury et al(1993) examined 87 patients with cervical cancer at Stage II or III by bipedal lymphangiogram, and only 50 patients were successfully dyed bilaterally.…”

Section: Discussionmentioning

confidence: 99%

“…In the past twenty years, lymphangiograms, surgical techniques, and placement of surgical clips were used to assess pelvic coverage of the conventional fields, and were applied as new precise methods for setting radiation field parameters by several western researchers (Greer et al, 1990;Bonin et al, 1996;Zunino et al, 1999;McAlpine et al, 2004). Although these techniques have confirmed the inadequate coverage of conventional pelvic radiation fields, they could not be prevalently applied due to several practical reasons.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Zhang

2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To evaluate the pelvic lymph node coverage of conventional pelvic fields based on bony landmarks in Chinese patients with cervical cancer by using computed tomography (CT) simulation images to contour pelvic vessels as substitutes for lymph nodes location. Methods: A retrospective review of CT simulation images and conventional pelvic radiation planning data sets was performed in 100 patients with cervical cancer at the International Federation of Gynecology and Obstetrics (FIGO) Stage IIB to IIIB in our hospital. Pelvic arteries were contoured on CT simulation images, and the outlines of conventional pelvic fields were drawn as defined by the gynecologic oncology group (GOG) after hiding the contours. The distances between the following vessel contours and field borders were measured: D 1 , the superior border of the anterior/posterior (AP) field and the bifurcation of abdominal aorta; D 2 , the ipsilateral border of the AP field and the distal end of external iliac artery; and D 3 , the anterior border of the lateral (LAT) field and the distal end of the external iliac artery. The distances were recorded as positive values if the measuring point was within the conventional pelvic fields, or they were recorded as negative values. Lymph nodes coverage was considered adequate when D 1 ≥0 mm, D 2 ≥17 mm or D 3 ≥7 mm. Results: All patients had at least 1 inadequate margin, 97 patients (97.0%) had 2, and 22 patients (22.0%) had all the 3. On the AP field, 95 patients (95%) had the measuring point, the bifurcation of the abdominal aorta, out of the field (D 1 <0 mm), and all the patients had a distance less than 17.0 mm between the distal end of the external iliac artery and ipsilateral border (D 2 <17.0 mm). On the LAT field, 24 patients (24%) had a distance less than 7.0 mm between the distal end of the external iliac artery and anterior border (D 3 <7.0 mm). Conclusion: We observed that conventional pelvic fields based on bony landmarks provided inadequate coverage of pelvic lymph nodes in our patients with cervical cancer. CT simulation may be a feasible technique for planning pelvic fields optimally and individually.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Zhang

2009

J. Zhejiang Univ. Sci. B

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“…However, without knowledge of the precise tumour volume it was potentially dangerous because of the risk of geographical miss of the tumour. Many observations indicating potential inadequate coverage of tumour volume have been substantiated by investigators using lymphangiography, computed tomography (CT) or magnetic resonance imaging (MRI) [1][2][3][4][5][6][7] . The aim of this paper is to describe the impact of MRI on the planning of radiotherapy before and after the availability of 3D imaging-based treatment planning systems.…”

Section: Planning Radiotherapy For Gynaecological Tumours 101mentioning

confidence: 99%

“…MRI offers the possibility of visualising the anatomy of the pelvis on all planes and enables much better evaluation of soft tissue structures and tumour depiction than CT [11][12][13][14][15][16] . Russell [3,6,7] . Zunino et al found that the borders of the lateral portals failed to involve PTV in over 50% of cases owing to uterus flexion and associated pathology (myoma, endometriosis, pyometra) [7] .…”

Section: Figurementioning

confidence: 99%

“…Russell [3,6,7] . Zunino et al found that the borders of the lateral portals failed to involve PTV in over 50% of cases owing to uterus flexion and associated pathology (myoma, endometriosis, pyometra) [7] . Thomas et al concluded that diagnostic MRI was a helpful tool for designing the irradiation fields but was not entirely sufficient because it did not fit the special needs of radiotherapy (Fig.…”

Section: Figurementioning

confidence: 99%

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The use of MRI in planning radiotherapy for gynaecological tumours

Barillot

Reynaud-Bougnoux²

2006

Cancer Imaging

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Parameters that significantly influence results in radiation treatment of gynaecological malignancies are mainly related to the tumour characteristics and the radiotherapy technique used. High-dose radiotherapy requires accurate localisation of the tumour volume and its relationship to surrounding normal tissues. For many years the standard technique used for irradiation of the pelvic area was the four-field box technique which offered the potential benefit of the lateral fields to shield the rectum and small bowel. However, this conventional technique was designed according to bony landmarks and offered limited information regarding the topography of the tumour and the flexion of the uterus which are influenced by the tumour burden and bladder and rectal filling. CT and MRI enable the visualisation of the cervix, uterus, vagina, iliac vessels and organs at risk, but MRI allows tumour depiction in all planes. In the early 1990s, several studies reported on the value of pelvic MRI in designing the lateral fields of the box technique. They demonstrated that conventional lateral portals would have resulted in a marginal tumour miss and incomplete coverage of the uterine fundus in more than 50% of cases, thus leading to the conclusion that if a box technique is used its design should be based on sagittal MRI. CT-based 3D planning systems are now routinely used in the vast majority of radiotherapy departments. Target volumes and organs at risk are delineated by the physician on each CT slice in order to conform the radiotherapy fields to the tumour volume. For several reasons, such as distortion and lack of electron density which is essential for dose calculation, the implementation of MRI into radiation treatment planning has its limitations. However, MRI can still be used if planning systems integrate tools for CT/MR image registration. There is little experience in the literature for gynaecological malignancies demonstrating that image fusion allows an improvement of the definition of the target and the organ at risk compared to CT alone. Only a few papers in the literature report on the use of CT/MR image registration in planning the external irradiation of gynaecological tumours. Most demonstrate feasibility, but they fail to quantify the improvement for volume definition compared to the use of CT alone. Finally, recent possibilities offered by MRI technology are promising in the area of brachytherapy planning as the full potential of individually defining and evaluating GTV and CTV based on tumour extent and anatomical structures is exploited.

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