Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines

Dapper, Hendrik; Habl, Gregor; Hirche, Christoph; Münch, Stefan; Oechsner, Markus; Mayinger, Michael; Sauter, Christina; Combs, Stephanie E.; Habermehl, Daniel

doi:10.1080/0284186x.2017.1415459

Cited by 6 publications

(8 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With both techniques a relevant volume of the AILD was not covered by 30 Gy. The results for the whole volume of the AILD were similar to our study in which we retrospectively analyzed the dose to the AILD in IMRT-treated patients [ 8 ]. Although the dose prescription in this study was slightly different, the Dmean was 41 Gy and V30Gy was 76 % compared to 38 Gy and senventy-3 % in the present study.…”

Section: Discussionsupporting

confidence: 80%

“…We defined the AILD on each patient almost identical to our previous AILD-fluorescence-study (Fig. 1 a) [ 8 ]. The cranial border of the AILD (the upper ischioanal fossa) was the origin of the levator ani muscle.…”

Section: Methodsmentioning

confidence: 99%

“…In our previous study we demonstrated, that especially the caudal parts of the AILD were insufficiently covered by the 30 Gy isodose in IMRT-treated patients [ 8 ]. In contrast, the cranial parts of the AILD (ischioanal fossa) were adjacent to the anal canal and usually covered by higher doses.…”

Section: Methodsmentioning

confidence: 99%

“…We recently published an analysis in which, for the first time, surgeons and radiation oncology specialists, presented a clearly defined anatomically area for the “true” AILD based on fluorescence-imaging method. We evaluated the dose distribution of VMAT-IMRT-treated anal cancer patients to this defined volume, showing that, in particular, the caudal areas of inguinal lymphatic drainage did not receive an adequate prophylactic dose for micrometastatic spread [ 8 ].…”

Section: Purposementioning

confidence: 99%

See 3 more Smart Citations

Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the “true” (deep) ano-inguinal lymphatic drainage of anal cancer patients

et al. 2018

Self Cite

View full text Add to dashboard Cite

IntroductionThe ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Currently, there are no recommendations for an inclusion of the ‘true’ AILD in the clinical target volume (CTV) of definitive chemoradiation for anal cancer patients. To estimate the relevance of inguinal recurrence, we compared the incidental dose to the AILD in anal cancer (AC) patients who were treated either with Volumetric Arc Therapy – Intensity Modulated Radiation Therapy (VMAT-IMRT) or conventional 3D-radiation technique.MethodsOne VMAT-IMRT-plans and one 3D-plans were calculated on the same target volumes and identical dose prescription in ten patients. We defined the volume of the AILD on the planning CT-scans based on the information of new fluorescence methods. Furthermore, we defined several anatomical subvolumes of interest inside the AILD. We examined and compared absolute and relative dosimetric parameters of the AILD and different anatomical subunits.ResultsThe Dmean of the AILD was 40 Gy in the 3D-group and 38 Gy in the IMRT-group. Dmean and Dmedian as well as the V30Gy of the AILD and all subvolumes of the caudal AILD were significant higher using 3D-RT compared to IMRT. Even though the absolute differences were small, in the caudal aspect of the ano-inguinal lymphatic drainage the V30Gy could be more than 10% less with VMAT-IMRT.Conclusions3D-RT was slightly superior to IMRT in terms of dose coverage of the AILD. However, the absolute differences were very small. Some relevant caudal parts of the AILD received an insufficient dose for treating potential micrometastases. Particularly in high-risk situations, this may lead to inguinal recurrence and therefore the true deep AILD should be included into the target volume in high risk patients.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

See 2 more Smart Citations

Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the “true” (deep) ano-inguinal lymphatic drainage of anal cancer patients

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Only two LN recurrences occurred at a pelvic site, while at least four patients had inguinal recurrences (4%, 6 LN) [25]. Furthermore, potential inguinal misses such the ones on superficial superomedial LNs could be identified in a PET imaging-based pattern of failure analysis in the context of established contouring guidelines ( [26]; Fig. 3).…”

Section: Inguinal Regionmentioning

confidence: 99%

Dosimetric comparison of organs at risk using different contouring guidelines for definition of the clinical target volume in anal cancer

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background There are different contouring guidelines for definition of the clinical target volume (CTV) for intensitymodulated radiation therapy (IMRT) of anal cancer (AC). We conducted a planning comparison study to evaluate and compare the dose to relevant organs at risk (OARs) while using different CTV definitions. Methods Twelve patients with a primary diagnosis of anal cancer, who were treated with primary chemoradiation (CRT), were selected. We generated four guideline-specific CTVs and subsequently planned target volumes (PTVs) on the planning CT scan of each patient. An IMRT plan for volumetric arc therapy (VMAT) was set up for each PTV. Dose parameters of the planned target volume (PTV) and OARs were evaluated and compared, too. Results The mean volume of the four PTVs ranged from 2138 cc to 2433 cc. The target volumes contoured by the authors based on the recommendations of each group were similar in the pelvis, while they differed significantly in the inguinal region. There were no significant differences between the four target volumes with regard to the dose parameters of the cranially located OARs. Conversely, some dose parameters concerning the genitals and the skin varied significantly among the different guidelines. Conclusion The four contouring guidelines differ significantly concerning the inguinal region. In order to avoid inguinal recurrence and to protect relevant OARs, further investigations are needed to generate uniform standards for definition of the elective clinical target volume in the inguinal region.

show abstract

Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer

Nilsson,

Undseth,

Albertsson

et al. 2023

Acta Oncologica

View full text Add to dashboard Cite

Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines

Cited by 6 publications

References 28 publications

Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the “true” (deep) ano-inguinal lymphatic drainage of anal cancer patients

Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the “true” (deep) ano-inguinal lymphatic drainage of anal cancer patients

Dosimetric comparison of organs at risk using different contouring guidelines for definition of the clinical target volume in anal cancer

Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer

Contact Info

Product

Resources

About