title: Radiation Therapy Oncology Group consensus panel guidelines for the delineation of the clinical target volume in the postoperative treatment of pancreatic head cancer.
abstract: OBJECTIVE
  To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer.
  
  
  METHODS
  A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions.
  
  
  RESULTS
  New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed.
  
  
  CONCLUSIONS
  The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. goodmank@mskcc.org
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.forename: Laura A
authors.initials: LA
authors.lastname: Dawson
authors.forename: Edgar
authors.initials: E
authors.lastname: Ben-Josef
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.forename: Walter R
authors.initials: WR
authors.lastname: Bosch
authors.forename: Julius
authors.initials: J
authors.lastname: Turian
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
mesh_terms: D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D001027:Aortography; D002445:Celiac Artery / Q000000981:diagnostic imaging; D032921:Consensus; D006801:Humans; D008488:Medical Illustration; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D058958:Organs at Risk / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D010193:Pancreaticojejunostomy; D011169:Portal Vein / Q000000981:diagnostic imaging; D018787:Radiation Oncology / Q000592:standards*; D011860:Radiography, Abdominal; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards; D047368:Tumor Burden