Improving target volume delineation in intact cervical carcinoma: Literature review and step-by-step pictorial atlas to aid contouring

Eminowicz, Gemma; Hall‐Craggs, Margaret A; Díez, Patricia; McCormack, Mary

doi:10.1016/j.prro.2016.01.006

Cited by 19 publications

(17 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 It is not clear whether it is interpretation of the definition (which patients to contour upper half, or two-thirds or the entire vagina 10 ) or the actual measurement of the vagina boundaries that gives rise to the variability seen. The current international prospective trial EMBRACE II includes a protocol for external beam radiotherapy contouring for cervical cancer which specifies that the vaginal CTV extends 2 cm inferior to the gross tumour only, 22,23 this simplified definition would presumably be easier for clinicians to contour and has been adopted by clinicians in the U.K. 24 Target volumes for cervical cancer are complex and consist of multiple individual target volumes, this research demonstrated that non-imaging related factors accounted for a significant amount of variation in the contours between clinicians, and this did not differ between contours on CT and MRI. Non-imaging related factors that can impact contours include the interpretation of guidelines and the clinician's education and experience.…”

Section: Discussionmentioning

confidence: 99%

Dedicated MRI simulation for cervical cancer radiation treatment planning: Assessing the impact on clinical target volume delineation

et al. 2018

View full text Add to dashboard Cite

Introduction: Magnetic Resonance Imaging (MRI) provides excellent soft tissue definition of pelvic tumours and organs. The aim of this study was to quantify differences in delineated clinical target volumes (CTVs) between computed tomography (CT) and MRI. Methods: Twenty patients with locally advanced gynaecological malignancies were recruited. Patients underwent dedicated MRI simulation following CT simulation. Four clinicians independently contoured each CT and MRI. CTV structures were contoured using the Radiation Therapy Oncology Group (RTOG) guidelines and lymph node CTV (LN-CTV) according to published guidelines. Interobserver variability was analysed using the dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Results: Gross tumour volume delineation was more consistent on MRI compared to CT, the DSC improved from 0.77 on CT to 0.81 on MRI, P < 0.01. GTV volumes were significantly smaller on MRI compared to CT (MRI 92 cc vs. CT 117 cc, P < 0.01). The LN-CTV and combined CTV volumes were both significantly smaller on MRI compared to CT (LN-CTV: MRI 324 cc vs CT 354 cc, P < 0.01 and combined CTV: MRI 560 cc vs CT 600 cc, P < 0.01). The LN-CTV DSC was 0.75 for both MRI and CT, and the combined CTV DSC was 0.81 for MRI and 0.80 for CT, P = 0.27. Vagina and parametria volumes exhibited more variability compared to other structures. Conclusions: Magnetic Resonance Imaging contouring resulted in smaller and more consistently delineated volumes when compared to CT for most CTV structures. An MRI contouring atlas is provided to complement the existing RTOG contouring guidelines.

show abstract

Section: Discussionmentioning

confidence: 99%

Dedicated MRI simulation for cervical cancer radiation treatment planning: Assessing the impact on clinical target volume delineation

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The EMBRACE II study protocol12 recommends mesorectal nodal inclusion if the patient has MRNM or if there is locally advanced cervical cancer. The INTERLACE study protocol quality assurance13 recommend including the mesorectum where there is clinical or radiological involvement by tumor. The Japan Clinical Oncology Group (JCOG) Radiation Therapy Study Group considers that including the entire mesorectum is too excessive for stage IIIB at this point, but additional discussion is required 14.…”

Section: Discussionmentioning

confidence: 99%

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Cordero-Gallardo

Burnett

McNamara

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveTo evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer.Methods/MaterialsWe performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated.ResultsThe incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III– IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1–IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013).ConclusionThis study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.

show abstract

“…Concepts regarding the gross target volume (GTV), clinical target volume (CTV), planning target volume (PTV), organs at risk (OARs) and dose-volume histogram (DVH) have been defined for use in conformal radiotherapy, especially for IMRT. [290][291][292] Point A, representing a paracervical reference point, has been the most widely used, validated, and reproducible dosing parameter used to date. However, limitations of the Point A dosing system include the fact that it does not take into account the three-dimension shape of tumors, nor individual tumor to normal tissue structure correlations.…”

Section: Radiation Treatment Planningmentioning

confidence: 99%

End of the minimal invasion surgery in cervical cancer?

Hernández¹

2018

Cancer Rep Rev

View full text Add to dashboard Cite

NCCN believes that the best management for any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at NCCN Member Institutions, click here: nccn.org/clinical_trials/physician.html. NCCN Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise indicated. See NCCN Categories of Evidence and Consensus.

show abstract

Improving target volume delineation in intact cervical carcinoma: Literature review and step-by-step pictorial atlas to aid contouring

Cited by 19 publications

References 45 publications

Dedicated MRI simulation for cervical cancer radiation treatment planning: Assessing the impact on clinical target volume delineation

Dedicated MRI simulation for cervical cancer radiation treatment planning: Assessing the impact on clinical target volume delineation

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

End of the minimal invasion surgery in cervical cancer?

Contact Info

Product

Resources

About