Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer

Abstract

Purpose: To develop an atlas of the clinical target volume (CTV) definitions for postoperative radiotherapy of endometrial and cervical cancer to be used for planning pelvic intensity-modulated radiotherapy.

Methods and materials: The Radiation Therapy Oncology Group led an international collaboration of cooperative groups in the development of the atlas. The groups included the Radiation Therapy Oncology Group, Gynecologic Oncology Group, National Cancer Institute of Canada, European Society of Therapeutic Radiology and Oncology, and American College of Radiology Imaging Network. The members of the group were asked by questionnaire to define the areas that were to be included in the CTV and to outline theses areas on individual computed tomography images. The initial formulation of the group began in late 2004 and culminated with a formal consensus conference in June 2005.

Results: The committee achieved a consensus CTV definition for postoperative therapy for endometrial and cervical cancer. The CTV should include the common, external, and internal iliac lymph node regions. The upper 3.0 cm of the vagina and paravaginal soft tissue lateral to the vagina should also be included. For patients with cervical cancer, or endometrial cancer with cervical stromal invasion, it is also recommended that the CTV include the presacral lymph node region.

Conclusion: This report serves as an international template for the definition of the CTV for postoperative intensity-modulated radiotherapy for endometrial and cervical cancer.

Conflict of interest statement

Conflicts of Interest Notification

William Small Jr., MD: None.

Loren Mell, MD: None.

Penny Anderson, MD: None.

Carien Creutzberg, MD: None.

Jennifer De Los Santos, MD: None.

David Gaffney, MD: None.

Anuja Jhingren, MD: None.

Lorraine Portelance, MD: None.

Tracey Schefter, MD: None.

Revathy, Iyer, MD: None.

Mahesh Varia, MD: None.

Kathryn Winter, MD: None.

Arno Mundt, MD: None.

Figures

Figure 1

Upper Common Iliac CTV

Figure 2

Mid Common Iliac (red) and Pre-sacral CTV (blue)

Figure 3

Lower Common Iliac (red) and Pre-sacral CTV (blue)

Figure 4

Upper External and Internal Iliac (red) and Pre-Sacral CTV (blue)

Figure 5

External and Internal Iliac CTV

Figure 6

External and Internal Iliac (red) and Parametrial/Vaginal (green) CTV

Figure 7

Parametrial/Vaginal CTV

Figure 8

Vaginal CTV