Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy
Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy
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DOI：
10.1016/j.ijrobp.2015.03.021
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发表时间：
2015-07-15
影响因子：
7
通讯作者：
Dearnaley, David
中科院分区：
文献类型：
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作者：
Harris, Victoria A.;Staffurth, John;Dearnaley, David
目的：本研究的目的是建立可重复的指导方针，划定临床靶体积（CTV）的盆腔淋巴结（LN）相结合的徒手皇家马斯登医院（RMH）和放射治疗肿瘤组（RTOG）血管扩张techniques.Methods和Materials：7例前列腺癌患者进行了标准的规划计算机断层扫描。为每名患者创建四种不同的CTV（RMH、RTOG、改良RTOG以及前列腺和骨盆相对于局部晚期前列腺癌的单独prOsTate治疗[PIVOTAL]试验），并创建6种不同的肠扩张边缘（BEM）以通过CTV评估肠回避。通过目视和使用Jaccard一致性指数对所得CTV进行比较。肠和规划目标体积（PTV）之间的重叠量进行测量，以帮助选择适当的边界元法，使最大的LN，但最小的正常组织coverage.Results：在总的，84结节轮廓进行了评价。所有组的LN覆盖范围相似，所有血管扩张技术（RTOG、改良RTOG和PIVOTAL）的CTV均大于RMH技术（平均体积分别为：287.3 cm（3）、326.7 cm（3）、310.3 cm（3）和256.7 cm（3））。改良RTOG PTV内的平均肠道体积为19.5 cm（3）（带0 mm BEM），17.4 cm（3）（1 mm BEM），10.8 cm（3）（2 mm BEM）、6.9 cm（3）（3 mm BEM）、5.0 cm（3）（4 mm BEM）和1.4 cm（3）（5 mm BEM），与使用RMH技术观察到的9.2 cm（3）重叠相比。从每种技术LN-CTVs之间的一致性评价显示类似的体积和coverage.Conclusions：血管扩张技术导致较大的LN-CTVs比徒手RMH技术。由于RMH技术得到I期和II期试验安全性数据的支持，我们建议对RTOG技术进行修改，包括增加3 mm BEM，这导致LN-CTV覆盖范围与RMH技术相似，减少了肠道和计划靶体积重叠。根据这些发现，在PIVOTAL试验中制定并实施了推荐指南，包括详细的骨盆LN轮廓图谱。(C)2015 Elsevier Inc. All rights reserved.
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 cm(3), 326.7 cm(3), 310.3 cm(3), and 256.7 cm(3), respectively). Mean volumes of bowel within the modified RTOG PTV were 19.5 cm(3) (with 0 mm BEM), 17.4 cm(3) (1-mm BEM), 10.8 cm(3) (2-mm BEM), 6.9 cm(3) (3-mm BEM), 5.0 cm(3) (4-mm BEM), and 1.4 cm(3) (5-mm BEM) in comparison with an overlap of 9.2 cm(3) 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. (C) 2015 Elsevier Inc. All rights reserved.