- 作者：Karyn A. Goodman ; M.D.&lowast ; ; goodmank@mskcc.org ; William F. Regine ; M.D.&dagger ; ; Laura A. Dawson ; M.D.&Dagger ; ; Edgar Ben-Josef ; M.D.§ ; ; Karin Haustermans ; M.D.鈥?/sup> ; Walter R. Bosch ; D.Sc.¶ ; ; Julius Turian ; Ph.D&lowast ; &lowast ; ; Ross A. Abrams ; M.D.&lowast ; &lowast ;
- 关键词：Pancreatic cancer ; Adjuvant radiotherapy ; Abdominal anatomy ; Intensity-modulated radiotherapy ; Consensus statement
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 July, 2012
- 卷：83
- 期：3
- 页码：901-908
- 文件大小：1961 K
Purpose
To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer.Methods and Materials
A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions.
Results
New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed.
Conclusions
The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.