title: RTOG sarcoma radiation oncologists reach consensus on gross tumor volume and clinical target volume on computed tomographic images for preoperative radiotherapy of primary soft tissue sarcoma of extremity in Radiation Therapy Oncology Group studies.
abstract: OBJECTIVE
  To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS).
  
  
  METHODS
  A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images.
  
  
  RESULTS
  A consensus was reached on appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface.
  
  
  CONCLUSIONS
  The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53045, USA. dwang@mcw.edu
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
authors.forename: Walter
authors.initials: W
authors.lastname: Bosch
authors.forename: David
authors.initials: D
authors.lastname: Roberge
authors.forename: Steven E
authors.initials: SE
authors.lastname: Finkelstein
authors.forename: Ivy
authors.initials: I
authors.lastname: Petersen
authors.forename: Michael
authors.initials: M
authors.lastname: Haddock
authors.forename: Yen-Lin E
authors.initials: YL
authors.lastname: Chen
authors.forename: Naoyuki G
authors.initials: NG
authors.lastname: Saito
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
authors.forename: Ying J
authors.initials: YJ
authors.lastname: Hitchcock
authors.forename: Aaron H
authors.initials: AH
authors.lastname: Wolfson
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
mesh_terms: D000465:Algorithms; D032921:Consensus; D003287:Contrast Media; D005121:Extremities / Q000473:pathology / Q000601:surgery; D006801:Humans; D008080:Liposarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008488:Medical Illustration; D011300:Preoperative Care; D018787:Radiation Oncology; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden
chemical_list: D003287:Contrast Media