TY - JOUR
T1 - International Consensus Guidelines for Adjuvant Radiation Therapy for Bladder Cancer After Radical Cystectomy
T2 - Update From an IBIS Workgroup
AU - Verghote, Flor
AU - Sargos, Paul
AU - Christodouleas, John P.
AU - Murthy, Vedang
AU - Baumann, Brian C.
AU - Dirix, Piet
AU - Berghen, Charlien
AU - Paelinck, Leen
AU - Vercauteren, Tom
AU - Fonteyne, Valérie
N1 - Funding Information:
Disclosures: Paul Sargos has received consulting fees from Roche, Bristol-Myers Squibb, and MSD and has received meeting/travel support from Bristol-Myers Squibb, all unrelated to this project. John P. Christodouleas reports employee status at Elekta. Brian C. Baumann discloses research funding from Varian, consulting with Varian and Boston Scientific, and medical advisory board service with Galera Therapeutics and Boston Scientific, all outside of the submitted work. Charlien Berghen has received meeting/travel support from Astellas Pharma and Ferring and discloses consulting for Jansen and Elekta, none of which is related to this work. Valérie Fonteyne is a postdoctorate clinical specialist funded by the Belgian Foundation against Cancer, has received grant funding from Ipsen, and has consulted for Ipsen and Janssen, all unrelated to this research project. The other authors declare no conflicts of interest.
Funding Information:
Sources of support: This research is funded by Kom op tegen Kanker (Stand up to Cancer), the Flemish cancer society (ref: 0010091). The granting bodies are not involved in data collection or analysis. Disclosures: Paul Sargos has received consulting fees from Roche, Bristol-Myers Squibb, and MSD and has received meeting/travel support from Bristol-Myers Squibb, all unrelated to this project. John P. Christodouleas reports employee status at Elekta. Brian C. Baumann discloses research funding from Varian, consulting with Varian and Boston Scientific, and medical advisory board service with Galera Therapeutics and Boston Scientific, all outside of the submitted work. Charlien Berghen has received meeting/travel support from Astellas Pharma and Ferring and discloses consulting for Jansen and Elekta, none of which is related to this work. Valérie Fonteyne is a postdoctorate clinical specialist funded by the Belgian Foundation against Cancer, has received grant funding from Ipsen, and has consulted for Ipsen and Janssen, all unrelated to this research project. The other authors declare no conflicts of interest.
Funding Information:
Sources of support: This research is funded by Kom op tegen Kanker (Stand up to Cancer), the Flemish cancer society (ref: 0010091). The granting bodies are not involved in data collection or analysis.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Purpose: In 2016, international consensus clinical target volume (CTV) guidelines for adjuvant radiation treatment after radical cystectomy in patients with muscle-invasive bladder cancer with high risk for locoregional failure (LRF) were published. A subsequent external validation study recommended several CTV optimizations (CTV-OPT). This study aimed to update international consensus guidelines based on new clinical experiences. Methods and Materials: Phase 1 (delineation interobserver variability): Four observers delineated the CTV of 9 patients post radical cystectomy, as in clinical practice. Interobserver agreement in contouring was evaluated using volume- and κ-statistics. Phase 2 (pattern of failure analysis): Among a prospective cohort of 72 patients treated with adjuvant radiation treatment, 11 developed LRF (10 available for review). LRFs were mapped in predefined pelvic subsites (ie, common, external and internal iliac, obturator and presacral node regions, and cystectomy bed), and their distance to CTV-OPT was measured. The actual delivered dose at each relapse site was calculated. Phase 3 (review CTV): Based on the results of phase 1 and 2, 5 senior radiation-oncologists (International Bladder Investigator Society) reviewed the published CTV borders and provided an update when indicated. Results: Phase 1: The mean overall κ-value was 0.66 (range, 0.60-0.70), indicating substantial overall agreement per Landis-Koch criteria. Specific κ-values per area indicated for the common iliac and obturator node regions only slight and moderate variability, respectively. Phase 2: Thirteen out of 16 LRFs centers were not included in the CTV-OPT. Ten LRF sites received a median dose <45 Gy, of which 6 were located in the cystectomy bed that was not included in the CTV because of negative radical cystectomy margins. Phase 3: Key recommendations by the panel were to include the entire common iliac node region and the cystectomy bed regardless of surgical margin status and a reaffirmation to not crop the CTV out of bowel. Conclusions: International consensus guidelines were updated.
AB - Purpose: In 2016, international consensus clinical target volume (CTV) guidelines for adjuvant radiation treatment after radical cystectomy in patients with muscle-invasive bladder cancer with high risk for locoregional failure (LRF) were published. A subsequent external validation study recommended several CTV optimizations (CTV-OPT). This study aimed to update international consensus guidelines based on new clinical experiences. Methods and Materials: Phase 1 (delineation interobserver variability): Four observers delineated the CTV of 9 patients post radical cystectomy, as in clinical practice. Interobserver agreement in contouring was evaluated using volume- and κ-statistics. Phase 2 (pattern of failure analysis): Among a prospective cohort of 72 patients treated with adjuvant radiation treatment, 11 developed LRF (10 available for review). LRFs were mapped in predefined pelvic subsites (ie, common, external and internal iliac, obturator and presacral node regions, and cystectomy bed), and their distance to CTV-OPT was measured. The actual delivered dose at each relapse site was calculated. Phase 3 (review CTV): Based on the results of phase 1 and 2, 5 senior radiation-oncologists (International Bladder Investigator Society) reviewed the published CTV borders and provided an update when indicated. Results: Phase 1: The mean overall κ-value was 0.66 (range, 0.60-0.70), indicating substantial overall agreement per Landis-Koch criteria. Specific κ-values per area indicated for the common iliac and obturator node regions only slight and moderate variability, respectively. Phase 2: Thirteen out of 16 LRFs centers were not included in the CTV-OPT. Ten LRF sites received a median dose <45 Gy, of which 6 were located in the cystectomy bed that was not included in the CTV because of negative radical cystectomy margins. Phase 3: Key recommendations by the panel were to include the entire common iliac node region and the cystectomy bed regardless of surgical margin status and a reaffirmation to not crop the CTV out of bowel. Conclusions: International consensus guidelines were updated.
UR - http://www.scopus.com/inward/record.url?scp=85136123309&partnerID=8YFLogxK
U2 - 10.1016/j.prro.2022.05.014
DO - 10.1016/j.prro.2022.05.014
M3 - Article
C2 - 35691550
AN - SCOPUS:85136123309
SN - 1879-8500
VL - 12
SP - 524
EP - 532
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 6
ER -