A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer.
OBJECTIVE
To develop a consensus-based guideline as well as an atlas defining pelvic nodal clinical target volumes in external beam radiotherapy for uterine cervical cancer.


METHODS
A working subgroup to establish the consensus-based guideline on clinical target volumes for uterine cervical cancer was formulated by the Radiation Therapy Study Group of the Japan Clinical Oncology Group in July 2008. The working subgroup consisted of seven radiation oncologists. The process resulting in the consensus included a comparison of contouring on CT images among the members, reviewing of published textbooks and the relevant literature and a distribution analysis of metastatic nodes on computed tomography/magnetic resonance imaging of actual patients.


RESULTS
The working subgroup defined the pelvic nodal clinical target volumes for cervical cancer and developed an associated atlas. As a basic criterion, the lymph node clinical target volume was defined as the area encompassed by a 7 mm margin around the applicable pelvic vessels. Modifications were made in each nodal area to cover adjacent adipose tissues at risk of microscopic nodal metastases. Although the bones and muscles were excluded, the bowel was not routinely excluded in the definition. Each of the following pelvic node regions was defined: common iliac, external iliac, internal iliac, obturator and presacral. Anatomical structures bordering each lymph node region were defined for six directions; anterior, posterior, lateral, medial, cranial and caudal. Drafts of the definition and the atlas were reviewed by members of the JCOG Gynecologic Cancer Study Group (GCSG).


CONCLUSIONS
We developed a consensus-based guideline defining the pelvic node clinical target volumes that included an atlas. The guideline will be continuously updated to reflect the ongoing changes in the field.
Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara-cho, Okinawa 903-0215, Japan. b983255@med.u-ryukyu.ac.jp
Takafumi
T
Toita
Tatsuya
T
Ohno
Yuko
Y
Kaneyasu
Takashi
T
Uno
Ryouichi
R
Yoshimura
Takeshi
T
Kodaira
Kazuhisa
K
Furutani
Goro
G
Kasuya
Satoshi
S
Ishikura
Toshiharu
T
Kamura
Masahiro
M
Hiraoka
D001271:Atlases as Topic; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D010388:Pelvis; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy*