title: Local recurrence map to guide target volume delineation after radical prostatectomy.
abstract: OBJECTIVE
  To describe the various anatomic locations of recurrent disease, in a cohort of men with radiographically visualized, biopsy-proven recurrent prostate cancer after radical prostatectomy (RP), in order to help guide contouring of the prostatic fossa clinical target volume (PF-CTV) when no gross recurrence is visible or when magnetic resonance imaging (MRI) is not used.
  
  
  METHODS
  Ten representative patients with MRI-detected, biopsy-proven local recurrences of prostate adenocarcinoma after RP were selected. Areas of recurrence were delineated on individual MRI images, and then mapped onto axial and sagittal "template" MRI images to compositely demonstrate the documented areas of recurrence. Coverage of these anatomic areas of recurrence was then evaluated by applying Radiation Therapy Oncology Group (RTOG)-consensus PF-CTV contours to a postoperative computed tomographic template.
  
  
  RESULTS
  The median age at the time of RP was 61 years (range, 50-73). In the superoinferior direction, recurrences ranged from the superior retrovesical region, to the inferior retrovesical region, to the posterior anastomosis, and as inferiorly as the posterior urogenital diaphragm. In the anteroposterior direction, the areas of recurrence ranged from involving the posterior bladder wall anteriorly to invading the rectum posteriorly. Recurrences were found at the center, right, and left of the prostate and seminal vesicle fossa. When target volumes were delineated using RTOG-defined consensus PF-CTV contours, coverage was marginal on recurrences in the posterolateral aspects of the CTV near the rectum and mesorectal fascia and lacking on recurrences occurring inferiorly at the posterior urogenital diaphragm.
  
  
  CONCLUSIONS
  Our findings describe the variation in location of prostate cancer recurrences and can be used to improve target definition in conformal radiation therapy in the postoperative adjuvant or salvage setting. RTOG-consensus contours for the PF-CTV should be applied carefully, with potential modifications in the posterolateral and inferior aspects.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jingya
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Rajat
authors.initials: R
authors.lastname: Kudchadker
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Seungtaek
authors.initials: S
authors.lastname: Choi
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Pettaway
authors.affiliation: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Haesun
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Bridget D
authors.initials: BD
authors.lastname: Hobbs
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Occena
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sean E
authors.initials: SE
authors.lastname: McGuire
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Karen
authors.initials: K
authors.lastname: Hoffman
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: dakuban@mdanderson.org.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies