Development of RTOG Consensus Guidelines for the Definition of the Clinical Target Volume for Postoperative Conformal Radiation Therapy for Prostate Cancer

Jeff M. Michalski, Colleen Lawton, Issam El Naqa, Mark Ritter, Elizabeth O'Meara, Michael J. Seider, W. Robert Lee, Seth A. Rosenthal, Thomas Pisansky, Charles Catton, Richard K Valicenti, Anthony L. Zietman, Walter R. Bosch, Howard Sandler, Mark K. Buyyounouski, Cynthia Ménard

Research output: Contribution to journalArticle

199 Scopus citations

Abstract

Purpose: To define a prostate fossa clinical target volume (PF-CTV) for Radiation Therapy Oncology Group (RTOG) trials using postoperative radiotherapy for prostate cancer. Methods and Materials: An RTOG-sponsored meeting was held to define an appropriate PF-CTV after radical prostatectomy. Data were presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed. Using contours independently submitted by 13 radiation oncologists, a statistical imputation method derived a preliminary "consensus" PF-CTV. Results: Starting from the model-derived CTV, consensus was reached for a CT image-based PF-CTV. The PF-CTV should extend superiorly from the level of the caudal vas deferens remnant to >8-12 mm inferior to vesicourethral anastomosis (VUA). Below the superior border of the pubic symphysis, the anterior border extends to the posterior aspect of the pubis and posteriorly to the rectum, where it may be concave at the level of the VUA. At this level, the lateral border extends to the levator ani. Above the pubic symphysis, the anterior border should encompass the posterior 1-2 cm of the bladder wall; posteriorly, it is bounded by the mesorectal fascia. At this level, the lateral border is the sacrorectogenitopubic fascia. Seminal vesicle remnants, if present, should be included in the CTV if there is pathologic evidence of their involvement. Conclusions: Consensus on postoperative PF-CTV for RT after prostatectomy was reached and is available as a CT image atlas on the RTOG website. This will allow uniformity in defining PF-CTV for clinical trials that include postprostatectomy RT.

Original languageEnglish (US)
Pages (from-to)361-368
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

Keywords

  • Conformal radiation therapy
  • Postoperative
  • Prostate cancer
  • Target volumes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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    Michalski, J. M., Lawton, C., El Naqa, I., Ritter, M., O'Meara, E., Seider, M. J., Lee, W. R., Rosenthal, S. A., Pisansky, T., Catton, C., Valicenti, R. K., Zietman, A. L., Bosch, W. R., Sandler, H., Buyyounouski, M. K., & Ménard, C. (2010). Development of RTOG Consensus Guidelines for the Definition of the Clinical Target Volume for Postoperative Conformal Radiation Therapy for Prostate Cancer. International Journal of Radiation Oncology Biology Physics, 76(2), 361-368. https://doi.org/10.1016/j.ijrobp.2009.02.006