Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer.
BACKGROUND
Radiotherapy (RT) is widely used in the treatment of pancreatic cancer. Currently, recommendation has been given for the delineation of the clinical target volume (CTV) in adjuvant RT. Based on recently reviewed pathologic data, the aim of this study is to propose criteria for the CTV definition and delineation including elective nodal irradiation (ENI) in the preoperative and definitive treatment of pancreatic cancer.


METHODS
The anatomical structures of interest, as well as the abdominal vasculature were identified on intravenous contrast-enhanced CT scans of two different patients with pancreatic cancer of the head and the body. To delineate the lymph node area, a margin of 10 mm was added to the arteries.


RESULTS
We proposed a set of guidelines for elective treatment of high-risk nodal areas and CTV delineation. Reference CT images were provided.


CONCLUSIONS
The proposed guidelines could be used for preoperative or definitive RT for carcinoma of the head and body of the pancreas. Further clinical investigations are needed to validate the defined CTVs.
Radiotherapy Unit, Department of Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del S, Cuore, Largo A, Gemelli 1, 86100, Campobasso, Italy.
Luciana
L
Caravatta
Giuseppina
G
Sallustio
Fabio
F
Pacelli
Gilbert D A
GD
Padula
Francesco
F
Deodato
Gabriella
G
Macchia
Mariangela
M
Massaccesi
Vincenzo
V
Picardi
Savino
S
Cilla
Alfonso
A
Marinelli
Numa
N
Cellini
Vincenzo
V
Valentini
Alessio G
AG
Morganti
D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011300:Preoperative Care; D018787:Radiation Oncology / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed