NRG Oncology/RTOG Consensus Guidelines for Delineation of Clinical Target Volume for Intensity Modulated Pelvic Radiation Therapy in Postoperative Treatment of Endometrial and Cervical Cancer: An Update

Small, William; Bosch, Walter; Harkenrider, M.M.; Strauss, Jonathan B.; Abu‐Rustum, Nadeem R.; Albuquerque, Kevin; Beriwal, Sushil; Creutzberg, Carien L.; Eifel, Patricia J.; Erickson, Beth; Fyles, Anthony; Hentz, Courtney; Jhingran, Anuja; Klopp, Ann H.; Kunos, Charles; Mell, Loren K.; Portelance, Lorraine; Powell, Melanie; Viswanathan, Akila N.; Yacoub, Joseph; Yashar, Catheryn M.; Winter, Kathryn; Gaffney, David K.

doi:10.1016/j.ijrobp.2020.08.061

Cited by 88 publications

(72 citation statements)

References 49 publications

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“…Appropriate delineation of the PA region is crucial in radiotherapy for cervical cancer patients, especially in a 3D or IMRT setting, in which a precise target delineation is highly necessary. However, to the best of our knowledge, only a limited number of studies are available about the delineation of the PA region of cervical cancer since the era of conformal radiotherapy (14,15,(17)(18)(19), and no study to date has reported patterns of PA recurrence after curative-intent treatment for cervical cancer. The current study, which presents recurrence patterns of PALNs and validation of PA CTVs proposed in previous studies, could provide further information for appropriate radiotherapy of the PA region in cervical cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a uniform margin around major vessels, such as the CTV M of our study, seems not suitable for cervical cancer. The recent update of RTOG guidelines recommended a minimal margin on the right, within 3 to 5 mm around IVC (15). The reason for recommending a small margin was because there was minimal evidence of nodal involvement to the right of the IVC.…”

Section: Discussionmentioning

confidence: 99%

“…Three previously proposed CTVs for the PA region were contoured on each patient and were reviewed for validation of PALN coverage. The rst PA CTV (CTV RTOG ) was contoured based on updated RTOG guidelines (expansion from the aorta 10 mm circumferentially, except 15 mm laterally, with further extension to the medial border of the left psoas muscle if needed; expansion from the IVC of 5 mm, up to left renal vein) (15). The second PA CTV (CTV K ) was contoured as proposed by Keenan et al (expansion from the aorta 10 mm circumferentially, except 15 mm laterally; expansion from the IVC of 8 mm anteromedial and 6 mm posterolaterally, up to left renal vein) (14).…”

Section: Ctv Coverage Analysismentioning

confidence: 99%

“…validated a proposed PA CTV with a separate patient cohort at the same time (14). Very recently, the NRG/Radiation Therapy Oncology Group (RTOG) updated consensus guidelines for delineation of CTV for intensity-modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer including the speci c PA CTV guideline (15). However, validations of these currently available guidelines through detailed PA recurrence patterns have been sparse to date.…”

Section: Introductionmentioning

confidence: 99%

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Mapping Patterns of Para-aortic Lymph Node Recurrence in Cervical Cancer: A Retrospective Cohort Analysis

Bae

Park

Jeong

et al. 2021

Preprint

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Background: To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV).Methods: Cervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTVRTOG was contoured based on the Radiation Therapy Oncology Group guideline. CTVK was contoured as proposed by Keenan et al. CTVM was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12–L1 interspace. CTVnew was created by modifying CTVRTOG to obtain better coverage.Results: We identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTVRTOG, CTVK, and CTVM covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTVnew to cover 96.7% of all PALNs and all nodes in 91.4% of patients.Conclusion: CTVRTOG and CTVK encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Ctv Coverage Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mapping Patterns of Para-aortic Lymph Node Recurrence in Cervical Cancer: A Retrospective Cohort Analysis

Bae

Park

Jeong

et al. 2021

Preprint

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“…Recently, Keenan et al proposed the first PA CTV contouring guideline, and the authors prospectively validated a proposed PA CTV with a separate patient cohort at the same time [ 14 ]. Very recently, the NRG/Radiation Therapy Oncology Group (RTOG) updated consensus guidelines for delineation of CTV for intensity-modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer including the specific PA CTV guideline [ 15 ]. However, validations of these currently available guidelines through detailed PA recurrence patterns have been sparse to date.…”

Section: Introductionmentioning

confidence: 99%

Mapping patterns of para-aortic lymph node recurrence in cervical cancer: a retrospective cohort analysis

et al. 2021

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Background To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV). Methods Cervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTVRTOG was contoured based on the Radiation Therapy Oncology Group guideline. CTVK was contoured as proposed by Keenan et al. CTVM was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12–L1 interspace. CTVnew was created by modifying CTVRTOG to obtain better coverage. Results We identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTVRTOG, CTVK, and CTVM covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTVnew to cover 96.7% of all PALNs and all nodes in 91.4% of patients. Conclusion CTVRTOG and CTVK encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.

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Half‐beam volumetric‐modulated arc therapy in adjuvant radiotherapy for gynecological cancers

Nien

et al. 2021

J Applied Clin Med Phys

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Purpose:The purpose of this study is to introduce half -beam volumetricmodulated arc therapy (HVMAT), an innovative treatment planning technique from our work, for reducing dose to the organs at risk (OAR) during adjuvant radiotherapy for gynecological cancers. Methods and materials: Seventy-two treatment plans of 36 patients with gynecological cancers receiving adjuvant radiotherapy were assessed. Among them, 36 plans were designed using HVMAT and paired with the other 36 traditional volumetric-modulated arc therapy (VMAT) plans for each patient. The main uniqueness of the HVMAT designs was that it consisted of two oppositeshielded half -beam fields rotated inversely in two coplanar arcs, collocating with the specially-devised avoidance structures to enhance the control of the OAR doses. The dose distributions in HVMAT and VMAT were evaluated and compared using the random effects model. Results:The ratios of OAR doses in HVMAT compared with VMAT showed a comprehensive OAR dose reduction when using HVMAT (V 20Gy : bladder, 0.92; rectum, 0.95; V 30Gy : bowel, 0.91; femoral heads, 0.66), except for the ilium (V 30Gy : 1.12). The overall mean difference for each OAR across V 40Gy , V 30Gy , V 20Gy , and bowel V 15Gy was statistically significant (almost all p < 0.001). In addition, HVMAT promoted a better conformity index, homogeneity index, D 2% , and V 107% of the planning target volume (all p < 0.001). Conclusions: HVMAT is capable of generating deep double-concave dose distributions with the advantage of reducing dose to several OARs simultaneously. It is highly recommended for pelvic irradiation, especially for treating gynecological cancers in adjuvant radiotherapy.

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NRG Oncology/RTOG Consensus Guidelines for Delineation of Clinical Target Volume for Intensity Modulated Pelvic Radiation Therapy in Postoperative Treatment of Endometrial and Cervical Cancer: An Update

Cited by 88 publications

References 49 publications

Mapping Patterns of Para-aortic Lymph Node Recurrence in Cervical Cancer: A Retrospective Cohort Analysis

Mapping Patterns of Para-aortic Lymph Node Recurrence in Cervical Cancer: A Retrospective Cohort Analysis

Mapping patterns of para-aortic lymph node recurrence in cervical cancer: a retrospective cohort analysis

Half‐beam volumetric‐modulated arc therapy in adjuvant radiotherapy for gynecological cancers

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