Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group

Variation in Clinical Target Volumes for Post-prostatectomy Patients and Effect on Normal Tissue Complication Probability

“…Based on these patterns, field border guidelines and consensus guidelines have been published [12][13][14][15]. Our findings suggest that, without an in situ anatomical structure for target delineation, physicians' contouring of post-prostatectomy regions-at-risk is variable, highlighting the need for development and adoption of such guidelines.…”

“…A review of published literature found six publications providing contouring guidelines for post-prostatectomy patients [12][13][14][15][22][23]. Of five primary guidelines, three were from the major oncology societies, one from Princess Margaret Hospital (PMH), and one from the Radiotherapy and Androgen Deprivation in Combination After Local Surgery (RADICALS) trial.…”

“…In this setting, prescribing physicians cannot base their clinical target volume (CTV) on the anatomical borders of a defined structure, but must rely on experience and published contouring atlases to determine regions at risk for microscopic disease, possibly increasing variation in treatment volume delineation [12][13][14][15]. Several atlases have been published, but in the critical comprehensive review of post-prostatectomy guidelines and atlases, Smith and Rodrigues [16] concluded that the clinical impact and reproducibility have not been clearly assessed.…”

Increased late urinary toxicity with whole pelvic radiotherapy after prostatectomy

“…EORTC giudelines 8 for the target volume definition in postoperative radiotherapy for prostate cancer, with the limitation of target volume to the sites of most probable local recurrence, enable a considerable reduction in dose-volume parameters of the urinary bladder. However, certain assurance is needed to exclude pelvic nodes.…”

Volumetric image-guided highly conformal radiotherapy of the prostate bed: Toxicity analysis

“…All patients underwent CT (2.5 slice thickness) under radiotherapy planning conditions in the supine position; bowel and bladder preparation were prescribed 11 in order to have an empty rectum and a full bladder during the CT scan and the treatment course. For each patient the clinical target volume (CTV), consisting of the prostate bed, was defined as suggested by Poortmans et al 12 Rectum and bladder were defined as solid organs; the rectum was considered from recto-sigmoid junction to the lowest level of the ischial tuberosities, and the bladder was contoured in its entirety. Planning target volumes (PTVs) were generated by an asymmetric expansion of CTVs (6 mm at the posterior margin, and 8 mm in all other directions).…”