title: Lymphatic drainage and CTV in pancreatic carcinoma.
abstract: CTV definition in exclusive or adjuvant radiation therapy of pancreatic carcinoma is essentially based on the opinion of "expert" authors and on the knowledge of lymphatic pathways. The subject has been widely debated. Radiotherapy treatments of the entire upper abdomen (liver and pancreatic region), pancreas and lymph node stations, to volumes focused on macroscopic tumor only, have been proposed. Carcinoma of exocrine pancreas is characterized by the frequent, early appearance of metastasis via the lymphatic route. Most commonly involved lymph node stations include those of the celiac trunk, superior mesenteric, peripancreatic, lumboaortic lymph nodes, those of the hepatic portal (the latter in particular for pancreatic head tumors) and of the hilum of spleen (the latter in particular for pancreatic tail tumors). The possible multicentricity of pancreatic carcinoma, most likely due to intraductal spread, should lead to the inclusion in the CTV of the entire pancreatic parenchyma. This should be considered also for the frequent perineural intra- or extrapancreatic spread of pancreatic carcinoma present also in small tumors (T1). In extrapancreatic spread the retropancreatic adipose tissue should be included in the CTV at least at the GTV level. At the present state of knowledge, in the absence of pattern of failure analysis and of comparison of different treatment approaches, in terms of the definition of volumes of interest, CTV definitions which include lymphatic drainage stations, most part of pancreatic parenchyma and retropancreatic adipose tissue seem justified especially in treatments for cure. In palliation, the CTV may be limited to the GTV and the adipose tissue behind it.
authors.affiliation: Cattedra di Radioterapia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Daniela
authors.initials: D
authors.lastname: Smaniotto
authors.forename: Stefano
authors.initials: S
authors.lastname: Luzi
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Lucio
authors.initials: L
authors.lastname: Trodella
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant