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Purpose-To define a prostate fossa clinical target volume (PF-CTV0 for Radiation Therapy Oncology Group (RTOG) trials utilizing post-operative radiotherapy for prostate cancer.Methods and Materials-An RTOG sponsored meeting was held to define an appropriate PF-CTV after radical prostatectomy. Data was presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed. Using contours independently Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.CONFLICT OF INTEREST STATEMENT: There are no conflicts of interest associated with this manuscript by any of the authors. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript submitted by 13 radiation oncologists, a statistical imputation method derived a preliminary "consensus" PF-CTV.Results-Starting from the model derived CTV, consensus was reached for a CT image-based PF-CTV. The PF-CTV should extend superiorly from the level of the caudal vas deferens remnant to > 8-12mm inferior to vesicourethral anastomosis (VUA). Below the superior border of the pubic symphysis, the anterior border extends to the posterior aspect of the pubis and posteriorly to the rectum where it may be concave at the level of the VUA. At this level the lateral border extends to the levator ani. Above the pubic symphysis the anterior border should encompass the posterior 1-2cm of the bladder wall and posteriorly it is bounded by the mesorectal fascia. At this level the lateral border is the sacrorectogenitopubic fascia. Seminal vesicle remnants, if present, should be included in the CTV if there is pathologic evidence of their involvement.Conclusions-Consensus on postoperative PF-CTV for RT after prostatectomy was reached and is available as a CT image atlas on the RTOG website. This will allow uniformity in defining PF-CTV for clinical trials that include post-prostatectomy RT.

Purpose-Radiation therapy to the pelvic lymph nodes in high risk prostate cancer is required on several RTOG clinical trials. Based on a prior lymph node contouring project we have shown significant disagreement in the definition of pelvic lymph node volumes amongst GU radiation oncology specialists involved in developing and executing current RTOG trials.Methods-A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data was presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop CTV pelvic lymph node consensus. Colleen A. Lawton, MD, Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee WI 53226, clawton@mcw.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Lymph node CTVs include the vessels (artery and vein) and a 7mm radial margin being careful to "carve out" bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on DVH constraints for OARs were also attained. Results-ConsensusConclusions-Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based CT images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment. The challenge is that there are significant differences of opinion regarding appropriate pelvic LN volumes to be treated in this cohort of patients. A 2007 survey of RTOG genitourinary cancer experts indicated that significant variability existed amongst a group of radiation oncologists experienced in the treatment of prostate cancer and design of prostate cancer clinical trials.(8) Given the widely adopted use of intensity modulated radiation therapy (IMRT) to treat the pelvic lymph nodes and spare organs at risk (OAR) it is imperative that a consensus be obtained to establish the appropriate nodal volumes for these patients so that the relative safety and merit of such treatment can be established. The purpose of this study was to establish such a consensus. Keywords METHODSGiven the established variability in LN treatment volumes by the RTOG GU Radiation Oncologists a consensus meeting was held on October 3, 2007 sponsored by the RTOG. All physicians/institutions involved in the original contouring project were invited to attend. (8) Data was presented (CL) to address the lymph node drainage of the prostate using prostatic lymphography, extended lymph node dissection, the sentinel lymph node conce...