目的:制定轮廓指南,用于放射治疗肿瘤学组方案0848,这是一项III期随机试验,评估辅助放化疗对切除的胰头癌患者的益处。
方法:由6位在胃肠道放疗方面具有专业知识的放射肿瘤学家组成的共识委员会制定了逐步轮廓指南和图集,用于描绘胰腺癌术后治疗中的临床目标体积(CTV)。基于可识别的兴趣区域和保证金扩张。定义了将纳入CTV的亚临床疾病风险区域,包括节点区域,吻合,术前原发肿瘤位置。确定了胰十二指肠切除术后可在术后影像学上重现轮廓的感兴趣区域。在多次迭代后,制定了涵盖风险区域的标准化扩展裕度,以确定最佳裕度扩展。
结果:建立了基于CT解剖的新轮廓评价建议。描绘术后CTV和正常组织的书面指南,以及基于网络的地图集,是开发的。
结论:术后腹部一直是有效放疗的难点。这些新指南将帮助医生创建更好地涵盖风险区域并最大程度地减少对正常组织的剂量的领域。
OBJECTIVE: 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: 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.