Definition of elective lymphatic target volume in ductal carcinoma of the pancreatic head based on histopathologic analysis.
OBJECTIVE
In chemoradiation for pancreatic carcinoma three-dimensional target volume definitions could maximize tolerability and therapeutic effect at the same time because toxicity correlates with treatment volume. We aimed to define guidelines for elective treatment of nodal areas based on pathologic nodal involvement to optimize treatment volume for this tumor.


METHODS
Pathologic patterns of regional nodal spread in 175 patients who underwent primary pancreatoduodenectomy with > or =10 assessed nodes and literature data on para-aortic spread were the base of the definition of the target volume. Significant correlations between spread to lymphatic areas and tumor characteristics were determined using Fisher's exact test. Computed tomography scans and a Pinnacle3 (Philips, Best, The Netherlands) system were used for treatment planning.


RESULTS
Among 175 resected tumors without pretreatment, 76% had regional nodal metastasis and 22% had spread to distant nodes. High-risk lymphatic areas were identified and selected for elective treatment. A standardized planning procedure was derived and tested under treatment conditions.


CONCLUSIONS
Histopathologic data allowed us to develop recommendations for standardized treatment planning for ductal carcinoma of the pancreatic head. These are proposed for quality assurance in multicenter studies and routine use.
Department of Radiation Oncology, Friedrich-Alexander University of Erlangen-Nuremberg, Universitätstrasse 27, 91054 Erlangen-Nuremberg, Germany. tb@strahlen.med.uni-erlangen.de
Thomas B
TB
Brunner
Susanne
S
Merkel
Gerhard G
GG
Grabenbauer
Thomas
T
Meyer
Ulrich
U
Baum
Thomas
T
Papadopoulos
Rolf
R
Sauer
Werner
W
Hohenberger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation / Q000379:methods / Q000592:standards*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000592:standards