RTOG GU Radiation Oncology Specialists Reach Consensus on Pelvic Lymph Node Volumes for High-Risk Prostate Cancer

Colleen A.F. Lawton, Jeff Michalski, Issam El-Naqa, Mark K. Buyyounouski, W. Robert Lee, Cynthia Menard, Elizabeth O'Meara, Seth A. Rosenthal, Mark Ritter, Michael Seider

Research output: Contribution to journalArticlepeer-review

295 Scopus citations

Abstract

Purpose: Radiation therapy to the pelvic lymph nodes in high-risk prostate cancer is required on several Radiation Therapy Oncology Group (RTOG) clinical trials. Based on a prior lymph node contouring project, we have shown significant disagreement in the definition of pelvic lymph node volumes among genitourinary radiation oncology specialists involved in developing and executing current RTOG trials. Materials and Methods: A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data were presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop clinical target volume (CTV) pelvic lymph node consensus. Results: Consensus was obtained resulting in computed tomography image-based pelvic lymph node CTVs. Based on this consensus, the pelvic lymph node volumes to be irradiated include: distal common iliac, presacral lymph nodes (S1-S3), external iliac lymph nodes, internal iliac lymph nodes, and obturator lymph nodes. Lymph node CTVs include the vessels (artery and vein) and a 7-mm radial margin being careful to "carve out" bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on dose-volume histogram constraints for OARs was also attained. Conclusions: Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based computed tomography images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment.

Original languageEnglish
Pages (from-to)383-387
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number2
DOIs
StatePublished - Jun 1 2009

Keywords

  • IMRT
  • Pelvic lymph nodes
  • Prostate cancer
  • Radiation oncology guidelines
  • Target volume

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