title: A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer.
abstract: OBJECTIVE
  To develop a consensus-based guideline to define clinical target volume for primary disease (clinical target volume primary) in external beam radiotherapy for intact uterine cervical cancer.
  
  
  METHODS
  The working subgroup of the JCOG Radiation Therapy Study Group began developing a guideline for primary clinical target volume in November 2009. The group consisted of 10 radiation oncologists and 2 gynecologic oncologists. The process started with comparing the contouring on computed tomographic images of actual cervical cancer cases among the members. This was followed by a comprehensive literature review that included primary research articles and textbooks as well as information on surgical procedures. Extensive discussion occurred in face-to-face meetings (three occasions) and frequent e-mail communications until a consensus was reached.
  
  
  RESULTS
  The working subgroup reached a consensus on the definition for the clinical target volume primary. The clinical target volume primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, vagina and ovaries. Definitions for these component structures were determined. Anatomical boundaries in all directions were defined for the parametrium. Examples delineating these boundaries were prepared for the posterior border of the parametrium for various clinical situations (i.e. central tumor bulk, degree of parametrial involvement).
  
  
  CONCLUSIONS
  A consensus-based guideline defining the clinical target volume primary was developed for external beam radiotherapy for intact uterine cervical cancer. This guideline will serve as a template for radiotherapy protocols in future clinical trials. It may also be used in actual clinical practice in the setting of highly precise external beam radiotherapy, including intensity-modulated radiotherapy.
authors.affiliation: Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan. b983255@med.u-ryukyu.ac.jp
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohno
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneyasu
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Kato
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatano
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Norihisa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kasamatsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Yoshimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishikura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000368:Aged; D032921:Consensus; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*