An atlas to aid delineation of para-aortic lymph node region in cervical cancer: Design and validation of contouring guidelines

Keenan, L.; Rock, Kathy; Azmi, A.; Salib, Osama; Gillham, Charles; McArdle, O.

doi:10.1016/j.radonc.2018.02.013

Cited by 33 publications

(59 citation statements)

References 20 publications

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“…Generally, the PALN region refers to the area adjacent to the aorta and inferior vena cava from the aortic bifurcation to T12. In the study of Keenan et al ( 67 ), all PALNs were inferior to the left renal vein. Takiar et al ( 68 ) reported that 96% of PALNs were in the inferior and middle third of the PALN region.…”

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 91%

“…PALNs are classified as left lateral para-aortic (LLPA), aorto-caval (AC), and right para-caval (PRC) PALNs based on their location. As shown in Table 1 , the mean distances from the LNs to adjacent anatomic structures are 8–22.1 mm in the LLPA region, 1.8–8 mm in the AC region and 5–9.1 mm in the PRC region ( 67 – 69 ). Most PALNs are located in the LLPA and AC regions.…”

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 97%

“…Most PALNs are located in the LLPA and AC regions. Only 4–6% of PALNs are located in the PRC region ( 67 , 68 , 70 ). As LNs in the PRC region are rare and the mean distance from the inferior vena cava to LNs in the PRC region is small, it is reasonable that the node CTV expansion from vessels can be small in the PRC region.…”

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 99%

“…As LNs in the PRC region are rare and the mean distance from the inferior vena cava to LNs in the PRC region is small, it is reasonable that the node CTV expansion from vessels can be small in the PRC region. Keenan et al ( 67 ) recommended a node CTV expansion of 10 mm circumferentially and 15 mm laterally from the aorta and of 8 mm anteromedially and 6 mm posterolaterally from the inferior vena cava to cover 97% of PALNs. In the study of Chao et al ( 69 ), to cover 100% of lymphangiography-aid PALNs, the node CTV comprised the aorta plus 2 cm and inferior vena cava plus 1 cm and the region 5 mm ventral to the aorta.…”

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 99%

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Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.

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Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 91%

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 97%

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 99%

Section: Delineation and Dose Prescription Of The Paln Regionmentioning

confidence: 99%

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Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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“…Probíhá výzkum nových prognostických a prediktivních V našem souboru pacientek je zřejmý přínos intenzivnější multimodální léčby pro OS i PFS -jedná se o retrospektivní analýzu souboru jednoho pracoviště, je tedy obtížné hodnotit statistickou významnost přínosu jednotlivých léčeb-tenkého střeva. Při užití těchto metod je nezbytná precizní konturace cílového objemu i přesné denní nastavení pacientek s užitím obrazem řízené radioterapie (Image Guided Radiation Therapy -IGRT) k dosažení lepší lokální kontroly onemocnění se zachováním přijatelné toxicity léčby [19,20]. Ve sledovaném období byla v Ústavu radiační onkologie Nemocnice Na Bulovce v Praze užívána pro léčbu gynekologických tumorů technika 3D-CRT, v současné době je již užívána technika VMAT s využitím IGRT.…”

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Treatment of Cervical Cancer with Paraaortic Lymph Node Involvement – Retrospective Review

Pechačová¹,

Kmoníčková²,

Křepelková³

et al. 2020

Klin Onkol

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Souhrn Východiska: Cílem sdělení je retrospektivní analýza výsledků léčby a toxicity v souboru pacientek s karcinomem hrdla děložního se vstupním metastatickým postižením paraaortálních lymfatických uzlin (PALU), které v Ústavu radiační onkologie Nemocnice Na Bulovce v Praze v letech 2005-2017 podstoupily kombinovanou (chemo)radioterapii. Soubor pacientek a metody: V uvedeném období bylo na pracovišti léčeno přes 800 pacientek s karcinomem hrdla děložního. Synchronní metastatické postižení limitované na oblast PALU bylo potvrzeno u 85 (10,6 %) pacientek. Kombinovanou (chemo)radioterapii s radikálním záměrem podstoupilo 57 (67,1 %) pacientek, paliativní radioterapie byla provedena u 26 (30,6 %) pacientek. Medián doby sledování v celém souboru je 24 měsíců. Výsledky: Ve skupině 57 pacientek léčených s radikálním záměrem podstoupily všechny pacientky zevní ozáření (external beam radiation therapy -EBRT) na oblast pánve a PALU, brachyterapie (BRT) byla aplikována u 55 (96,5 %) pacientek, konkomitantní chemoterapie (CHT) cDDP 1× týdně byla podávána u 17 (29,8 %) pacientek. Akutní toxicita G3-4 dle kritérií RTOG (Radiation Therapy Oncology Group) byla zaznamenána u 7 (12,3 %) pacientek, pozdní toxicita G3-4 u 7 (12,3 %) pacientek. Management léčby nežádoucích účinků probíhá v multidisciplinárních týmech. V podskupině pacientek léčených kombinací EBRT + BRT + CHT bylo dosaženo mediánu doby do progrese (progression-free survival -PFS) 37,3 měsíce a celkového přežití (overall survival -OS) 39,2 měsíce, Kaplan-Meierův odhad přežití v 5 letech je 46,8 %. V podskupině léčené EBRT + BRT byl zjištěn medián PFS 22,7 měsíce, medián OS 30,3 měsíce, odhad přežití v 5 letech je 38,6 %. Závěr: Kombinovaná (chemo)radioterapie u pokročilého karcinomu děložního hrdla vstupně s metastázami do PALU potvrdila v našem souboru pacientek významný benefit v PFS a OS. Zastoupení akutní i pozdní toxicity je akceptovatelné a pro dosažení maximálního léčebného přínosu je nezbytná multidisciplinární podpůrná léčba. Klíčová slovakarcinom děložního hrdla -metastázy -radioterapie -chemoradioterapie -brachyterapiepaliativní péče -podpůrná léčba Podpořeno Ústavem radiační onkologie, Nemocnice Na Bulovce, Praha.

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A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

Wang

Liu

et al. 2021

Cancer Medicine

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Purpose To validate the nodal center coverage (NCC) of the three mainstream delineation methods of para‐aortic nodal clinical target volume (CTV) and propose a modified delineation method of para‐aortic nodal CTV in prophylactic extended‐field irradiation (EFI) of cervical cancer. Methods A total of 106 patients with para‐aortic lymph nodes (PALNs) identified on PET/CT were included at Peking Union Medical College Hospital between 2011 and 2020. PALNs were classified as left lateral para‐aortic (LLPA), aorto‐caval (AC), and right para‐caval (RPC). Distances from the nodal center to the aorta and inferior vena cava (IVC) were measured. The NCC of the three mainstream delineation methods of para‐aortic nodal CTV (CTV‐K, CTV‐S, and CTV‐D) and a modified CTV (CTV‐M) was calculated. Radiotherapy plans were created based on 4 CTVs for 10 selected patients who received prophylactic EFI. The chi‐squared test and the Student's t‐test were performed. Results We identified 344 PALNs (216 LLPA, 101 AC, and 27 RPC) in 106 patients. Mean distance from the nodal center to the aorta was 9.6 mm in the LLPA and 7 mm in the AC and from the nodal center to the IVC was 5.6 mm in the AC and 5.6 mm in the RPC. CTV‐D improved the NCC of 98% compared with 92% for CTV‐K (p = 0.002) and 95% for CTV‐S (p = 0.046). CTV‐M provided the same satisfactory NCC as CTV‐D (97% vs. 98%, p = 0.485). The V50Gy to the duodenum, the Dmean to the bilateral kidneys, and the V45Gy to the small bowel were significantly lower on the CTV‐M‐based plan than on the CTV‐D‐based plan (p = 0.001, 0.011, and 0.001, respectively). Conclusion CTV‐D provided more satisfactory NCC than CTV‐K and CTV‐S. CTV‐M provided the same satisfactory NCC as CTV‐D and reduced the dose to the critical structures.

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An atlas to aid delineation of para-aortic lymph node region in cervical cancer: Design and validation of contouring guidelines

Cited by 33 publications

References 20 publications

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

Treatment of Cervical Cancer with Paraaortic Lymph Node Involvement – Retrospective Review

A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

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