Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy

Bonin, Steven R.; Lanciano, Rachelle; Corn, Benjamin W.; Hogan, W. J.; Hartz, William H.; Hanks, Gerald E.

doi:10.1016/0360-3016(95)02055-1

Cited by 53 publications

(33 citation statements)

References 19 publications

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“…It was found that an optimal external irradiation to prevent the locoregional relapse required an adequate coverage of pelvic lymph nodes (Bonin et al, 1996). However, in most cases conventional pelvic fields based on bony landmarks could not provide adequate radiation area.…”

Section: Discussionmentioning

confidence: 99%

“…Lymphangiograms, surgical techniques and CT/MRI imaging (Bonin et al, 1996;Zunino et al, 1999;McAlpine et al, 2004) were used to identify the adequacy of pelvic lymph node coverage in the past few years. Pendlebury et al(1993) examined 87 patients with cervical cancer at Stage II or III by bipedal lymphangiogram, and only 50 patients were successfully dyed bilaterally.…”

Section: Discussionmentioning

confidence: 99%

“…Effective therapy needs covering an adequate area of the tissues at risk for metastasis (Tewari and Monk, 2009). Pelvic lymph nodes were involved in 15%∼30% of patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IB/II cervical cancer and 45%∼60% with Stage III (Bonin et al, 1996). Optimal treatment requires a combined approach including intracavitary radiation for in situ tumor and external radiation for parametrial tissue and pelvic draining lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

“…In the past twenty years, lymphangiograms, surgical techniques, and placement of surgical clips were used to assess pelvic coverage of the conventional fields, and were applied as new precise methods for setting radiation field parameters by several western researchers (Greer et al, 1990;Bonin et al, 1996;Zunino et al, 1999;McAlpine et al, 2004). Although these techniques have confirmed the inadequate coverage of conventional pelvic radiation fields, they could not be prevalently applied due to several practical reasons.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Zhang

2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To evaluate the pelvic lymph node coverage of conventional pelvic fields based on bony landmarks in Chinese patients with cervical cancer by using computed tomography (CT) simulation images to contour pelvic vessels as substitutes for lymph nodes location. Methods: A retrospective review of CT simulation images and conventional pelvic radiation planning data sets was performed in 100 patients with cervical cancer at the International Federation of Gynecology and Obstetrics (FIGO) Stage IIB to IIIB in our hospital. Pelvic arteries were contoured on CT simulation images, and the outlines of conventional pelvic fields were drawn as defined by the gynecologic oncology group (GOG) after hiding the contours. The distances between the following vessel contours and field borders were measured: D 1 , the superior border of the anterior/posterior (AP) field and the bifurcation of abdominal aorta; D 2 , the ipsilateral border of the AP field and the distal end of external iliac artery; and D 3 , the anterior border of the lateral (LAT) field and the distal end of the external iliac artery. The distances were recorded as positive values if the measuring point was within the conventional pelvic fields, or they were recorded as negative values. Lymph nodes coverage was considered adequate when D 1 ≥0 mm, D 2 ≥17 mm or D 3 ≥7 mm. Results: All patients had at least 1 inadequate margin, 97 patients (97.0%) had 2, and 22 patients (22.0%) had all the 3. On the AP field, 95 patients (95%) had the measuring point, the bifurcation of the abdominal aorta, out of the field (D 1 <0 mm), and all the patients had a distance less than 17.0 mm between the distal end of the external iliac artery and ipsilateral border (D 2 <17.0 mm). On the LAT field, 24 patients (24%) had a distance less than 7.0 mm between the distal end of the external iliac artery and anterior border (D 3 <7.0 mm). Conclusion: We observed that conventional pelvic fields based on bony landmarks provided inadequate coverage of pelvic lymph nodes in our patients with cervical cancer. CT simulation may be a feasible technique for planning pelvic fields optimally and individually.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Zhang

2009

J. Zhejiang Univ. Sci. B

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“…However, as shown by the Gynecologic Oncology Group (GOG), LAG has a sensitivity of 79% and speci®city of 73%, whereas CT and ultrasound have sensitivities of 34 and 19%, and speci®ci-ties of 96 and 99%, respectively [15]. The importance and utility of LAG, especially if external radiotherapy is planned, is con®rmed by the work of Bonin et al, who demonstrated that bony landmarks are not an adequate substitute for LAG for the localization of pelvic lymph nodes [3]. Some authors are convinced that LAG remains the tool of choice in order to de®ne target volumes and ®eld limits for external radiation [3].…”

Section: Pretreatment Evaluation and Staging In Cervical Cancermentioning

confidence: 99%

A survey on staging and treatment in uterine cervical carcinoma in the Radiotherapy Cooperative Group of the European Organization for Research and Treatment of Cancer

Coucke

Maingon

Ciernik

et al. 2000

Radiotherapy and Oncology

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Background: The treatment outcome of advanced stage uterine cervical carcinoma remains unsatisfactory. In order to elaborate a novel trial within The Radiotherapy Cooperative Group (RCG) of the European Organization for Research and Treatment of Cancer (EORTC), we conducted a survey in 1997±1998 to determine the variability of pre-treatment assessment and treatment options. The variability of choosing surgery, de®ned radiation therapy techniques and chemotherapy are investigated, as well as the center's choices of future treatment strategies.Methods: Fifty two of 81 RCG centers from the RCG have participated in the survey. As one would expect, there is a large variation in the techniques used for pretreatment evaluation and treatment options. There is no`standard' for reporting acute and late side effects. Chemotherapy is used neither systematically nor uniformly, and some centers continue to use neadjuvant chemotherapy modalities.Results: Furthermore, the survey reveals that there is a strong demand for the reduction of overall treatment-time, for clinical investigation of novel combined modality treatment strategies, especially chemo±radiation therapy, and also for the use of new radiation sensitizers.Conclusion: We conclude that a more homogeneous approach to the pretreatment evaluation as well as treatment techniques is required in order to allow adequate quality control in any future trial of the RCG in the EORTC. q

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Image-Guided Radiation Therapy in Gynecology Applications

Eng

Baseman

Nguyen

et al. 2013

Image-Guided Cancer Therapy

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Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy

Cited by 53 publications

References 19 publications

Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

Evaluation of pelvic lymph node coverage of conventional radiotherapy fields based on bony landmarks in Chinese cervical cancer patients using CT simulation

A survey on staging and treatment in uterine cervical carcinoma in the Radiotherapy Cooperative Group of the European Organization for Research and Treatment of Cancer

Image-Guided Radiation Therapy in Gynecology Applications

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