RTOG GU Radiation Oncology Specialists Reach Consensus on Pelvic Lymph Node Volumes for High-Risk Prostate Cancer

Abstract

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...

Impact of 18F-Fluciclovine PET on Target Volume Definition for Postprostatectomy Salvage Radiotherapy: Initial Findings from a Randomized Trial

“…The patients in both arms are assessed during therapy weekly for toxicity and then at 1,6,12,18,24,30, and 36 mo for toxicity (both provider-reported and patient-reported) and disease control. The primary endpoint of the study is 3-y disease-free survival.…”

“…Treatment-planning MR (at 3 tesla, using a T2-weighted pulse sequence) is also done for all patients, and prostate bed volumes are defined according to the RTOG consensus. For patients receiving nodal treatment, the RTOG pelvic atlas is used to define the nodal volume (24). At the time of radiotherapy simulation, the rectum, bladder (minus clinical treatment volume), penile bulb, and femoral heads are outlined for each patient in a manner that adheres with RTOG studies (8,24,25).…”

“…For patients receiving nodal treatment, the RTOG pelvic atlas is used to define the nodal volume (24). At the time of radiotherapy simulation, the rectum, bladder (minus clinical treatment volume), penile bulb, and femoral heads are outlined for each patient in a manner that adheres with RTOG studies (8,24,25). In particular, the filled bladder is outlined from the apex to the dome, and the rectum is outlined from the ischial tuberosities to the rectosigmoid junction.…”

Accelerated tomotherapy delivery with TomoEdge technique

“…The modality chosen for treatment differed distinctly for the respective localizations: irradiation of the prostate alone could be performed with Edge 5 without hampering target coverage or organ at risk (OAR) sparing, while the use of a 5 cm beam substantially increased the dose to small bowel and bladder when the pelvic lymph nodes according to the RTOG consensus (10) was included. Thus, Edge 2.5 was used.…”

“…In our first clinical experience, we found two general exceptions to the applicability of Edge 5 mode: First, in irradiation plans of prostate and pelvic lymph nodes according to the RTOG consensus (10) that included the presacral space while sparing rectum, small bowel, and bladder, the use of Edge 5 exposed larger parts of bladder and small bowel to high dose levels than a 2.5 cm field width (see Table 3). A similar problem occurred in cases of head and neck cancer with involvement of the skull that exceeded the base of skull: a 5 cm field width resulted in higher brain exposure than the 2.5 cm plan.…”