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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
Journal article   Open access   Peer reviewed

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

William Small, Jr, Walter R Bosch, Mathew M Harkenrider, Jonathan B Strauss, Nadeem Abu-Rustum, Kevin V Albuquerque, Sushil Beriwal, Carien L Creutzberg, Patricia J Eifel, Beth A Erickson, …
International journal of radiation oncology, biology, physics, v 109(2), pp 413-424
01 Feb 2021
DOI: https://doi.org/10.1016/j.ijrobp.2020.08.061
PMID: 32905846
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://hdl.handle.net/1887/3280418View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open
url
https://doi.org/10.1016/j.ijrobp.2020.08.061View
Published, Version of Record (VoR) Open

Abstract

Consensus Documentation Endometrial Neoplasms - diagnostic imaging Endometrial Neoplasms - radiotherapy Endometrial Neoplasms - surgery Female Humans Internationality Organs at Risk - radiation effects Postoperative Period Practice Guidelines as Topic Radiotherapy Planning, Computer-Assisted Radiotherapy, Intensity-Modulated - adverse effects Societies, Medical Tomography, X-Ray Computed Uterine Cervical Neoplasms - diagnostic imaging Uterine Cervical Neoplasms - radiotherapy Uterine Cervical Neoplasms - surgery
Accurate target definition is critical for the appropriate application of radiation therapy. In 2008, the Radiation Therapy Oncology Group (RTOG) published an international collaborative atlas to define the clinical target volume (CTV) for intensity modulated pelvic radiation therapy in the postoperative treatment of endometrial and cervical cancer. The current project is an updated consensus of CTV definitions, with removal of all references to bony landmarks and inclusion of the para-aortic and inferior obturator nodal regions. An international consensus guideline working group discussed modifications of the current atlas and areas of controversy. A document was prepared to assist in contouring definitions. A sample case abdominopelvic computed tomographic image was made available, on which experts contoured targets. Targets were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation with kappa statistics as a measure of agreement between observers. Sixteen participants provided 13 sets of contours. Participants were asked to provide separate contours of the following areas: vaginal cuff, obturator, internal iliac, external iliac, presacral, common iliac, and para-aortic regions. There was substantial agreement for the common iliac region (sensitivity 0.71, specificity 0.981, kappa 0.64), moderate agreement in the external iliac, para-aortic, internal iliac and vaginal cuff regions (sensitivity 0.66, 0.74, 0.62, 0.59; specificity 0.989, 0.966, 0.986, 0.976; kappa 0.60, 0.58, 0.52, 0.47, respectively), and fair agreement in the presacral and obturator regions (sensitivity 0.55, 0.35; specificity 0.986, 0.988; kappa 0.36, 0.21, respectively). A 95% agreement contour was smoothed and a final contour atlas was produced according to consensus. Agreement among the participants was most consistent in the common iliac region and least in the presacral and obturator nodal regions. The consensus volumes formed the basis of the updated NRG/RTOG Oncology postoperative atlas. Continued patterns of recurrence research are encouraged to refine these volumes.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Oncology
Radiology, Nuclear Medicine & Medical Imaging
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